MEDICARE: MS. LOURDES PATRICIA MEJIA NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	21316	CA
2	363LF0000X	Family Nurse Practitioner	AP60616598	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21316	OTHER	CA	21316

General Provider Information

NPI Number	:	1326301094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LOURDES PATRICIA MEJIA NP

Provider Business Mailing Address
First Line	:	4214 W BEVERLY BLVD
Second Line	:	STE 212
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-4429
Country	:	US
Telephone Number	:	213-385-9912
Fax Number	:	213-385-9915

Provider Business Practice Location Address
First Line	:	4214 BEVERLY BLVD
Second Line	:	STE 212
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-4479
Country	:	US
Telephone Number	:	213-385-9912
Fax Number	:	213-385-9915

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2012
Last Update Date	:	03/10/2020

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