Healthcare Provider Details

I. General information

NPI: 1871199786
Provider Name (Legal Business Name): NORA LIZ MEJIAS GONZALEZ MD, MHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 12/07/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CALLE MIGUEL CASILLAS
HUMACAO PR
00791-3638
US

IV. Provider business mailing address

PO BOX 1364
GURABO PR
00778-1364
US

V. Phone/Fax

Practice location:
  • Phone: 787-285-5959
  • Fax:
Mailing address:
  • Phone: 787-604-0157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number22101
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: