Healthcare Provider Details

I. General information

NPI: 1649145418
Provider Name (Legal Business Name): IDAMARIS MEJIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/09/2025
Certification Date: 09/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 C DR. PEDRO ALBIZU CAMPOS
LARES PR
00669
US

IV. Provider business mailing address

E25 CALLE TORRIMAR
MAYAGUEZ PR
00682-1323
US

V. Phone/Fax

Practice location:
  • Phone: 939-291-0144
  • Fax:
Mailing address:
  • Phone: 787-406-1848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4645
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: