Provider Demographics
NPI:1588354344
Name:JOSUE ERNESTO MEJIA COVARRUBIAS
Entity type:Organization
Organization Name:JOSUE ERNESTO MEJIA COVARRUBIAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSUE
Authorized Official - Middle Name:ERNESTO
Authorized Official - Last Name:MEJIA COVARRUBIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-272-9021
Mailing Address - Street 1:2364 PASEO DE LAS AMERICAS # 1755
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-5224
Mailing Address - Country:US
Mailing Address - Phone:619-272-9021
Mailing Address - Fax:
Practice Address - Street 1:LIBRAMIENTO ORIENTE 6237 INT-6
Practice Address - Street 2:JARDINES DE AGUA CALIENTE
Practice Address - City:TIJUANA
Practice Address - State:BAJJA CALIFORNIA
Practice Address - Zip Code:22194
Practice Address - Country:MX
Practice Address - Phone:619-272-9021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty