MEDICARE: LUISA MESA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1356814578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUISA MESA

Provider Business Mailing Address
First Line	:	14008 SW 55TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-5913
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14008 SW 55TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-5913
Country	:	US
Telephone Number	:	786-374-7848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2019
Last Update Date	:	01/10/2019

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Directions to “ LUISA MESA ” Practice Location

Language	Start Address	Practice Location

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