Provider Demographics
NPI:1982699559
Name:MEJIA, JORGE (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:MEJIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WINSTON CHURCHILL AVE
Mailing Address - Street 2:PMB 364 SUITE 1
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-616-0032
Mailing Address - Fax:787-822-6298
Practice Address - Street 1:371 AVE DE DIEGO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1711
Practice Address - Country:US
Practice Address - Phone:787-754-4244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13958208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20769Medicare ID - Type Unspecified
PRH67544Medicare UPIN