Healthcare Provider Details

I. General information

NPI: 1487187530
Provider Name (Legal Business Name): ADRIAN ALBERTO MEJIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 SAMUELL BLVD
DALLAS TX
75228-6828
US

IV. Provider business mailing address

5323 HARRY HINES BLVD
DALLAS TX
75390-8589
US

V. Phone/Fax

Practice location:
  • Phone: 972-861-5611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberBP30081569
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP20072965
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberV4152
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: