Provider Demographics
NPI:1417215070
Name:MEJIA, JOSE MIGUEL JR (CST/CSFA)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:MIGUEL
Last Name:MEJIA
Suffix:JR
Gender:M
Credentials:CST/CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12902 ESSEN FRST
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-3790
Mailing Address - Country:US
Mailing Address - Phone:210-683-4452
Mailing Address - Fax:
Practice Address - Street 1:12902 ESSEN FRST
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-3790
Practice Address - Country:US
Practice Address - Phone:210-683-4452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant