Provider Demographics
NPI:1104976059
Name:MEJIAS, MANUEL EDWARD JR (PA)
Entity type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:EDWARD
Last Name:MEJIAS
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3705 N ELLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-1154
Mailing Address - Country:US
Mailing Address - Phone:559-274-1120
Mailing Address - Fax:559-274-1120
Practice Address - Street 1:1300 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-3845
Practice Address - Country:US
Practice Address - Phone:559-295-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12717363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical