Healthcare Provider Details

I. General information

NPI: 1386509982
Provider Name (Legal Business Name): ROSA MEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32921 WILDOMAR RD
LAKE ELSINORE CA
92530-4671
US

IV. Provider business mailing address

32921 WILDOMAR RD
LAKE ELSINORE CA
92530-4671
US

V. Phone/Fax

Practice location:
  • Phone: 951-285-4043
  • Fax:
Mailing address:
  • Phone: 951-285-4043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number230110756
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: