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General NPI Number Information
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NPI Number | 1194952754
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Entity Type | Individual
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Provider Name | MELISSA YOLANDA MEJIA DISLA MD
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Gender | Female
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Dates
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Enumeration Date | 06/22/2009
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 690 S GOLDENROD RD
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City | ORLANDO
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State | FL
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Zip | 32822-8108
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Country | US
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Telephone | 407-792-1144
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Fax | 407-232-9807
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Provider Business Mailing Address
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Address Line | 690 S GOLDENROD RD
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City | ORLANDO
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State | FL
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Zip | 32822-8108
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Country | US
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Telephone | 407-792-1144
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Fax | 407-232-9807
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | ME116099
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME116099
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License Number State | FL
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