Provider Demographics
NPI:1326022435
Name:MEJIA-O'NEILL, MARIA ELENA (PT MPT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:MEJIA-O'NEILL
Suffix:
Gender:F
Credentials:PT MPT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ELENA
Other - Last Name:MEJIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT MPT
Mailing Address - Street 1:6987 BLUE ORCHID LN
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-5164
Mailing Address - Country:US
Mailing Address - Phone:760-390-5049
Mailing Address - Fax:
Practice Address - Street 1:1922 HACIENDA DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6024
Practice Address - Country:US
Practice Address - Phone:760-295-4175
Practice Address - Fax:760-295-4176
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT84300OtherBLUE SHIELD OF CALIFORNIA
CAWPT8430AMedicare PIN