Healthcare Provider Details

I. General information

NPI: 1477729192
Provider Name (Legal Business Name): MARIO ALBERTO MEJIA SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 8TH ST
BAY CITY TX
77414-5434
US

IV. Provider business mailing address

3005 8TH ST
BAY CITY TX
77414-5434
US

V. Phone/Fax

Practice location:
  • Phone: 409-457-3796
  • Fax:
Mailing address:
  • Phone: 409-457-3796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number08-173
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: