=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487381679
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIJAH JAMES MEJIA CAJIGAL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2022
-----------------------------------------------------
Last Update Date | 08/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 GARLAND ST
-----------------------------------------------------
City | EVERETT
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02149-5066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 627-061-7389
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 508 ELLIOTT ST APT 2L
-----------------------------------------------------
City | BEVERLY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01915-2349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZS0410X
-----------------------------------------------------
Taxonomy Name | Surgical Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------