MEDICARE: EDALID VERENICE MEZA

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	:	1750156303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDALID VERENICE MEZA

Provider Business Mailing Address
First Line	:	7114 TREVES DR
Second Line	:
City	:	PARAMOUNT
State	:	CA
Zip	:	90723-7156
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10004 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-4494
Country	:	US
Telephone Number	:	888-800-9270
Fax Number	:

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

Provider Enumeration Date	:	11/22/2023
Last Update Date	:	11/22/2023

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Directions to “ EDALID VERENICE MEZA ” Practice Location

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