Basic Information
| Provider Information | |||||||||
| NPI: | 1003151705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEJIA | ||||||||
| FirstName: | MAGGIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AP, DOM | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 112 ORANGE AVE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321144338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3869445855 | ||||||||
| FaxNumber: | 3869445855 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 ORANGE AVE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321144338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3869445855 | ||||||||
| FaxNumber: | 3869445855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2012 | ||||||||
| LastUpdateDate: | 12/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | AP 3133 | FL | Y | Other Service Providers | Acupuncturist |
No ID Information.