Healthcare Provider Details

I. General information

NPI: 1568220580
Provider Name (Legal Business Name): EMILY CARDENAS MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 03/13/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 FOOTHILL RD STE 1
RENO NV
89511-5448
US

IV. Provider business mailing address

178 E FIST AVE
SUNVALLEY NV
89433
US

V. Phone/Fax

Practice location:
  • Phone: 775-851-1770
  • Fax:
Mailing address:
  • Phone: 775-247-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: