Provider Demographics
NPI:1407211881
Name:MEJIA, ERNEST RITUALO (PA)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:RITUALO
Last Name:MEJIA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 W 35TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-7926
Mailing Address - Country:US
Mailing Address - Phone:619-427-3361
Mailing Address - Fax:
Practice Address - Street 1:22 W 35TH ST STE 101
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7926
Practice Address - Country:US
Practice Address - Phone:619-427-3361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53105363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical