Healthcare Provider Details

I. General information

NPI: 1235279399
Provider Name (Legal Business Name): RAFAEL E MEJIA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COROZAL 'AVENUE' 53
MOROVIS PR
00687
US

IV. Provider business mailing address

PO BOX 419
MOROVIS PR
00687-0419
US

V. Phone/Fax

Practice location:
  • Phone: 787-862-5235
  • Fax: 787-862-5235
Mailing address:
  • Phone: 787-862-5235
  • Fax: 787-862-5235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD-2297
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: