Provider Demographics
NPI:1346621935
Name:MEJIA, LISA A (RDN,LDN,CDCDES,IFNCP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:MEJIA
Suffix:
Gender:F
Credentials:RDN,LDN,CDCDES,IFNCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 FRUITLAND DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-4594
Mailing Address - Country:US
Mailing Address - Phone:786-923-6039
Mailing Address - Fax:
Practice Address - Street 1:1720 FRUITLAND DR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-4594
Practice Address - Country:US
Practice Address - Phone:786-923-6039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007271133V00000X
AL5461133V00000X
MA4698-NU-NU133V00000X
FLND6219133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered