Healthcare Provider Details

I. General information

NPI: 1881312916
Provider Name (Legal Business Name): LUCIA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 N SAM HOUSTON PKWY W STE 240
HOUSTON TX
77086-1466
US

IV. Provider business mailing address

4100 N SAM HOUSTON PKWY W STE 240
HOUSTON TX
77086-1466
US

V. Phone/Fax

Practice location:
  • Phone: 832-968-7155
  • Fax:
Mailing address:
  • Phone: 832-968-7155
  • Fax: 713-383-9795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number42178
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: