Provider Demographics
NPI:1992972848
Name:MEJIA, OTTONIEL ANTONIO (DPM)
Entity type:Individual
Prefix:DR
First Name:OTTONIEL
Middle Name:ANTONIO
Last Name:MEJIA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 UCLA MEDICAL PLZ
Mailing Address - Street 2:# 460
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-0001
Mailing Address - Country:US
Mailing Address - Phone:310-443-8999
Mailing Address - Fax:310-208-4847
Practice Address - Street 1:100 UCLA MEDICAL PLZ
Practice Address - Street 2:# 460
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-443-8999
Practice Address - Fax:310-208-4847
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4779213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist