Provider Demographics
NPI:1316437221
Name:MEJIA, DORA MARIA (IN HOME SUPPORT)
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:MARIA
Last Name:MEJIA
Suffix:
Gender:F
Credentials:IN HOME SUPPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 W BUSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7704
Mailing Address - Country:US
Mailing Address - Phone:813-531-0360
Mailing Address - Fax:813-252-9688
Practice Address - Street 1:1020 W BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7704
Practice Address - Country:US
Practice Address - Phone:813-531-0360
Practice Address - Fax:813-252-9688
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker