Healthcare Provider Details

I. General information

NPI: 1831150374
Provider Name (Legal Business Name): JUAN A. MEJIA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 DENVER ST
SALT LAKE CITY UT
84111-3002
US

IV. Provider business mailing address

327 DENVER ST
SALT LAKE CITY UT
84111-3002
US

V. Phone/Fax

Practice location:
  • Phone: 801-328-4500
  • Fax: 801-328-4565
Mailing address:
  • Phone: 801-328-4500
  • Fax: 801-328-4565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1112732501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: