Provider Demographics
NPI:1366994477
Name:MAYORA-MEJIA DENTAL CORPORATION
Entity type:Organization
Organization Name:MAYORA-MEJIA DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:LUZ
Authorized Official - Last Name:MAYORA-MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-352-6378
Mailing Address - Street 1:PO BOX 2550
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-2550
Mailing Address - Country:US
Mailing Address - Phone:619-422-0800
Mailing Address - Fax:619-422-3060
Practice Address - Street 1:8341 LA MESA BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0217
Practice Address - Country:US
Practice Address - Phone:619-422-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51972122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty