Healthcare Provider Details

I. General information

NPI: 1659195824
Provider Name (Legal Business Name): YESENIA MEJIA URIETA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8259 SOUTHWESTERN BLVD APT 1065
DALLAS TX
75206-2140
US

IV. Provider business mailing address

8259 SOUTHWESTERN BLVD APT 1065
DALLAS TX
75206-2140
US

V. Phone/Fax

Practice location:
  • Phone: 469-386-4662
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number230889
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: