Individual
JACQUELINE LISSETTE MEJIA LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SA-C
Contact information
Practice address
2925 W 80TH ST APT 224, HIALEAH, FL 33018-3835
(786) 450-9236
Mailing address
2925 W 80TH ST APT 224, HIALEAH, FL 33018-3835
(786) 450-9236
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
19-486
WI
Other
Enumeration date
12/23/2019
Last updated
12/23/2019
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