Healthcare Provider Details

I. General information

NPI: 1699409516
Provider Name (Legal Business Name): KATHY MEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 FELICE DR
HOLLISTER CA
95023-3361
US

IV. Provider business mailing address

351 FELICE DR
HOLLISTER CA
95023-3361
US

V. Phone/Fax

Practice location:
  • Phone: 831-634-2123
  • Fax:
Mailing address:
  • Phone: 831-634-2123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: