Healthcare Provider Details

I. General information

NPI: 1497295091
Provider Name (Legal Business Name): CASSANDRA MAE MEJIA RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 AIRPORT AVE STE F
ROSENBERG TX
77471-5759
US

IV. Provider business mailing address

4910 AIRPORT AVE STE D
ROSENBERG TX
77471-5759
US

V. Phone/Fax

Practice location:
  • Phone: 281-239-1435
  • Fax: 281-239-0828
Mailing address:
  • Phone: 281-239-1435
  • Fax: 281-239-0828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number17-29759
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: