Provider Demographics
NPI:1174317473
Name:MEJIA, EMMANUEL CARLOS (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:CARLOS
Last Name:MEJIA
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 FRANKLIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3208
Mailing Address - Country:US
Mailing Address - Phone:510-529-5352
Mailing Address - Fax:
Practice Address - Street 1:1404 FRANKLIN ST STE 200
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3208
Practice Address - Country:US
Practice Address - Phone:510-529-5352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95174417163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health