Healthcare Provider Details

I. General information

NPI: 1770309346
Provider Name (Legal Business Name): CHRISTOPHER MEJIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2024
Last Update Date: 11/28/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 BEDFORD RD
BEDFORD TX
76021-6985
US

IV. Provider business mailing address

4745 DORSEY ST
FOREST HILL TX
76119-7518
US

V. Phone/Fax

Practice location:
  • Phone: 817-508-0030
  • Fax:
Mailing address:
  • Phone: 682-252-5116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number44252
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: