Provider Demographics
NPI:1538887153
Name:RODRIGUEZ MEJIA, BRENDA E
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:E
Last Name:RODRIGUEZ MEJIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 CEDAR AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3807
Mailing Address - Country:US
Mailing Address - Phone:612-270-8522
Mailing Address - Fax:
Practice Address - Street 1:3751 17TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-2807
Practice Address - Country:US
Practice Address - Phone:612-721-6118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker