Individual provider Active NPI

Marcos Mejia

  • Registered Nurse
  • Los Angeles, CA
National Provider Identifier
1053065581
Registry record updated Feb 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
95084119 Issued in CA
Practice address
1711 W Temple St
Los Angeles, CA 90026-7329
Phone
(213) 989-6100
NPI assigned
Feb 3, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 3, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 95084119 CA Primary

Addresses

Primary practice location

1711 W Temple St
Los Angeles, CA 90026-7329

Mailing address

1711 W Temple St
Los Angeles, CA 90026-7329
Phone (213) 989-6100

Other identifiers 1

IdentifierTypeStateIssuer
1780183335MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Azalea Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
95084119CAMDRegistered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643846400000",
    "number": "1053065581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1711 W TEMPLE ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900267329",
            "telephone_number": "213-989-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 W TEMPLE ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900267329",
            "telephone_number": "213-989-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEJIA",
        "first_name": "MARCOS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-02-03",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95084119",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1780183335",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Azalea",
            "affiliation": "N",
            "endpointDescription": "Azalea",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Azalea",
            "address_1": "1711 W Temple St",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900267329",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.