Provider Demographics
NPI:1235674698
Name:MEJIA, BLANCA SOLEDAD (MS,NL,CNS)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:SOLEDAD
Last Name:MEJIA
Suffix:
Gender:F
Credentials:MS,NL,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 CLARKS LN
Mailing Address - Street 2:APT A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-2624
Mailing Address - Country:US
Mailing Address - Phone:443-835-7721
Mailing Address - Fax:
Practice Address - Street 1:11110 MEDICAL CAMPUS RD STE 108
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6734
Practice Address - Country:US
Practice Address - Phone:301-714-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4039133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education