Provider Demographics
NPI:1265057756
Name:MEJIA, MICHAEL ENRIQUE (PARAMEDIC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ENRIQUE
Last Name:MEJIA
Suffix:
Gender:M
Credentials:PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 LAKE LINDLEY DR N
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-4103
Mailing Address - Country:US
Mailing Address - Phone:407-304-6077
Mailing Address - Fax:
Practice Address - Street 1:1 JEFF FUQUA BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-4392
Practice Address - Country:US
Practice Address - Phone:407-825-3042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLEMT535937146N00000X
FLPMD525206146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic