Healthcare Provider Details

I. General information

NPI: 1366179657
Provider Name (Legal Business Name): TASHIRA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/05/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE DIEZ ANDINO 177 APT.1B
SAN JUAN PR
00911
US

IV. Provider business mailing address

CALLE DIEZ ANDINO 177 APT. 1B
SAN JUAN PR
00911
US

V. Phone/Fax

Practice location:
  • Phone: 939-422-0445
  • Fax:
Mailing address:
  • Phone: 939-422-0445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number97288
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: