Provider Demographics
NPI:1326301094
Name:MEJIA, LOURDES PATRICIA (NP)
Entity Type:Individual
Prefix:MS
First Name:LOURDES
Middle Name:PATRICIA
Last Name:MEJIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4214 W BEVERLY BLVD
Mailing Address - Street 2:STE 212
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-4429
Mailing Address - Country:US
Mailing Address - Phone:213-385-9912
Mailing Address - Fax:213-385-9915
Practice Address - Street 1:4214 BEVERLY BLVD
Practice Address - Street 2:STE 212
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-4479
Practice Address - Country:US
Practice Address - Phone:213-385-9912
Practice Address - Fax:213-385-9915
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA21316164W00000X
WAAP60616598363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21316Other21316