Provider Demographics
NPI:1023468212
Name:MEJIA DE GARCIA, BERTHA O
Entity type:Individual
Prefix:
First Name:BERTHA
Middle Name:O
Last Name:MEJIA DE GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 E KILMER ST
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2132
Mailing Address - Country:US
Mailing Address - Phone:240-640-3796
Mailing Address - Fax:
Practice Address - Street 1:7205 E KILMER ST
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2132
Practice Address - Country:US
Practice Address - Phone:240-640-3796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16-384246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant