Provider Demographics
NPI:1508955170
Name:MEJIA, MIGUEL ANGEL ESPIN (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGEL ESPIN
Last Name:MEJIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:320 GOLDEN SHR STE 201
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4243
Mailing Address - Country:US
Mailing Address - Phone:186-620-9107
Mailing Address - Fax:156-226-4255
Practice Address - Street 1:15211 VANOWEN ST STE 206
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3620
Practice Address - Country:US
Practice Address - Phone:181-878-7847
Practice Address - Fax:181-878-7867
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG42563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00425630Medicaid
CA00425630Medicaid
E74650Medicare UPIN