Provider Demographics
NPI:1245963545
Name:MEJIA, SEBASTIAN ALEJANDRO (PA)
Entity type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:ALEJANDRO
Last Name:MEJIA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 MITCHELL RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-4920
Mailing Address - Country:US
Mailing Address - Phone:209-581-9711
Mailing Address - Fax:209-581-9703
Practice Address - Street 1:1340 MITCHELL RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-4920
Practice Address - Country:US
Practice Address - Phone:209-581-9711
Practice Address - Fax:209-581-9703
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65083363A00000X
FLPA9119376363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant