Healthcare Provider Details

I. General information

NPI: 1891080347
Provider Name (Legal Business Name): RUBIN MEJIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 SHALLOWFORD RD SUITE 443
CHATTANOOGA TN
37421-2285
US

IV. Provider business mailing address

2211 DENTON DR SUITE J
AUSTIN TX
78758-4543
US

V. Phone/Fax

Practice location:
  • Phone: 423-756-2268
  • Fax: 423-266-9690
Mailing address:
  • Phone: 512-833-9956
  • Fax: 800-530-4382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: