Healthcare Provider Details

I. General information

NPI: 1902348469
Provider Name (Legal Business Name): CHRIS N MEJIA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 E MAIN ST
MEDFORD OR
97504-7689
US

IV. Provider business mailing address

1025 E MAIN ST
MEDFORD OR
97504-7689
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-1282
  • Fax:
Mailing address:
  • Phone: 541-779-1282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number219117
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: