Provider Demographics
NPI:1477729192
Name:MEJIA, MARIO ALBERTO (LSA, RN, SA-C)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:ALBERTO
Last Name:MEJIA
Suffix:
Gender:M
Credentials:LSA, RN, SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 CLEAR LAKE CITY BLVD
Mailing Address - Street 2:SUITE 180-187
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-8120
Mailing Address - Country:US
Mailing Address - Phone:409-457-3796
Mailing Address - Fax:
Practice Address - Street 1:2323 CLEAR LAKE CITY BLVD
Practice Address - Street 2:SUITE 180-187
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-8120
Practice Address - Country:US
Practice Address - Phone:409-457-3796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX729339163W00000X
TXSA00339163WR0006X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No163W00000XNursing Service ProvidersRegistered Nurse
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant