Healthcare Provider Details

I. General information

NPI: 1134778574
Provider Name (Legal Business Name): ANDREA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 WEBBER ST
THE DALLES OR
97058-3749
US

IV. Provider business mailing address

1060 WEBBER ST
THE DALLES OR
97058-3749
US

V. Phone/Fax

Practice location:
  • Phone: 541-296-5452
  • Fax:
Mailing address:
  • Phone: 541-296-5452
  • Fax: 541-296-1537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: