=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649145418
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IDAMARIS MEJIAS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2025
-----------------------------------------------------
Last Update Date | 10/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 C DR. PEDRO ALBIZU CAMPOS
-----------------------------------------------------
City | LARES
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-291-0144
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | E25 CALLE TORRIMAR
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00682-1323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-406-1848
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 4645
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------