MEDICARE: CARLOS E MEZA M.D.

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	207R00000X	Internal Medicine Physician	A31428	CA
2	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	A31428	CA

General Provider Information

NPI Number	:	1730104761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS E MEZA M.D.

Provider Business Mailing Address
First Line	:	1805 N CALIFORNIA ST STE 202
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-6032
Country	:	US
Telephone Number	:	209-944-9063
Fax Number	:	209-944-9339

Provider Business Practice Location Address
First Line	:	1805 N CALIFORNIA ST STE 202
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-6032
Country	:	US
Telephone Number	:	209-944-9063
Fax Number	:	209-944-9339

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	09/11/2025

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