Individual provider Active NPI

Lisa A Mejia, RDN,LDN,CDCDES,IFNCP

  • Registered Dietitian
  • Deltona, FL
National Provider Identifier
1346621935
Registry record updated May 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
ND6219 Issued in FL
Practice address
1720 Fruitland Dr
Deltona, FL 32725-4594
Phone
(786) 923-6039
NPI assigned
Jun 9, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 17, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X L007271 NC
Registered Dietitian 133V00000X 5461 AL
Registered Dietitian 133V00000X 4698-NU-NU MA
Registered Dietitian 133V00000X ND6219 FL Primary

Addresses

Primary practice location

1720 Fruitland Dr
Deltona, FL 32725-4594

Mailing address

1720 Fruitland Dr
Deltona, FL 32725-4594
Phone (786) 923-6039

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160225000746 FL Practitioner - Registered Dietitian Or Nutrition Professional 6709181944 Reassigns benefits to 2 organizations
Practice locations: Spring Hill, FL

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4698MAMDCounselor
4698-NU-NUMAMDRegistered Dietitian
L007271NCMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Bienestar Nutrition LLC CurrentSince Jun 6, 2025 Accepting new patients
Mayo Clinic Jacksonville CurrentSince Jan 4, 2021 Accepting new patients
Mayo Clinic Jacksonville CurrentSince Jan 4, 2021 Accepting new patients

Locations

4500 San Pablo Rd S
Jacksonville, FL 32224
Phone (904) 721-4815

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1433808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715904000000",
    "number": "1346621935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 FRUITLAND DR",
            "city": "DELTONA",
            "state": "FL",
            "postal_code": "327254594",
            "telephone_number": "786-923-6039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 FRUITLAND DR",
            "city": "DELTONA",
            "state": "FL",
            "postal_code": "327254594",
            "telephone_number": "786-923-6039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEJIA",
        "first_name": "LISA",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "RDN,LDN,CDCDES,IFNCP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-09",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": "L007271",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "AL",
            "license": "5461",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MA",
            "license": "4698-NU-NU",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "ND6219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deltona, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.