Provider Demographics
NPI:1811889926
Name:SANDOVAL MEJIA, KATE
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:SANDOVAL MEJIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 W SIERRA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019-1233
Mailing Address - Country:US
Mailing Address - Phone:623-330-2143
Mailing Address - Fax:
Practice Address - Street 1:3033 N CENTRAL AVE STE 145
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2808
Practice Address - Country:US
Practice Address - Phone:623-583-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86445931133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered