Provider Demographics
NPI:1558706804
Name:MEJIA-PEREZ, MARIA NATIVIDAD (DPM)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:NATIVIDAD
Last Name:MEJIA-PEREZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12214 LAKEWOOD BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2663
Mailing Address - Country:US
Mailing Address - Phone:562-862-2775
Mailing Address - Fax:562-904-8095
Practice Address - Street 1:12214 LAKEWOOD BLVD STE 110
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2663
Practice Address - Country:US
Practice Address - Phone:562-862-2775
Practice Address - Fax:562-904-8095
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5053213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery