MEDICARE: MR. MARIO ALBERTO MEJIA SA-C

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	246ZC0007X	Surgical Assistant	08-173	TX
2	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1477729192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARIO ALBERTO MEJIA SA-C

Provider Business Mailing Address
First Line	:	3005 8TH ST
Second Line	:
City	:	BAY CITY
State	:	TX
Zip	:	77414-5434
Country	:	US
Telephone Number	:	409-457-3796
Fax Number	:

Provider Business Practice Location Address
First Line	:	3005 8TH ST
Second Line	:
City	:	BAY CITY
State	:	TX
Zip	:	77414-5434
Country	:	US
Telephone Number	:	409-457-3796
Fax Number	:

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

Provider Enumeration Date	:	05/02/2008
Last Update Date	:	10/29/2024

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