Provider Demographics
NPI:1801053673
Name:MEJIA, JORGE ENRIQUE (LAC)
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:ENRIQUE
Last Name:MEJIA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:513 VALENCIA ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1168
Mailing Address - Country:US
Mailing Address - Phone:415-518-3503
Mailing Address - Fax:415-355-9990
Practice Address - Street 1:513 VALENCIA ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1168
Practice Address - Country:US
Practice Address - Phone:415-518-3503
Practice Address - Fax:415-355-9990
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12175171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist