Provider Demographics
NPI:1568274793
Name:ROQUE MEJIA, ERIK ALAN
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:ALAN
Last Name:ROQUE MEJIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 NAPLES DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-4274
Mailing Address - Country:US
Mailing Address - Phone:469-583-1169
Mailing Address - Fax:
Practice Address - Street 1:411 N WASHINGTON AVE STE 5000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1792
Practice Address - Country:US
Practice Address - Phone:214-820-9225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125167225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist