Healthcare Provider Details

I. General information

NPI: 1427767367
Provider Name (Legal Business Name): MARIA FERNANDA MEJIA RDN, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 OLD MAIN HILL
LOGAN UT
84322
US

IV. Provider business mailing address

332 E 300 S
LOGAN UT
84321
US

V. Phone/Fax

Practice location:
  • Phone: 435-797-4200
  • Fax: 844-308-5865
Mailing address:
  • Phone: 435-213-5919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number12888342-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: