Provider Demographics
NPI:1750818084
Name:MEJIA, EARL JASON (MD)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:JASON
Last Name:MEJIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:310-354-4200
Mailing Address - Fax:
Practice Address - Street 1:2175 PARK PL
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4705
Practice Address - Country:US
Practice Address - Phone:310-354-4200
Practice Address - Fax:775-982-4196
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19871207R00000X, 208M00000X
CAA171128208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine