Healthcare Provider Details

I. General information

NPI: 1902093750
Provider Name (Legal Business Name): LAURA C MEJIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 CALLE MENDEZ VIGO
DORADO PR
00646-4908
US

IV. Provider business mailing address

100 PASEO SAN PABLO ARTURO CADILLA BUILDING SUITE 401
BAYAMON PR
00961-7022
US

V. Phone/Fax

Practice location:
  • Phone: 787-278-1147
  • Fax:
Mailing address:
  • Phone: 787-786-7391
  • Fax: 787-798-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number6619
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: