Individual
CARLOS R MEJIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
724 W 20TH ST, HAZLETON, PA 18201-1702
(570) 599-4008
Mailing address
724 W 20TH ST, HAZLETON, PA 18201-1702
(570) 599-4008
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
29880670
PA
Other
Enumeration date
05/02/2012
Last updated
05/02/2012
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