Healthcare Provider Details

I. General information

NPI: 1134917891
Provider Name (Legal Business Name): ANDREA MEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 W 22ND ST
LOS ANGELES CA
90007-1405
US

IV. Provider business mailing address

465 E 47TH ST
LOS ANGELES CA
90011-3901
US

V. Phone/Fax

Practice location:
  • Phone: 415-762-3700
  • Fax:
Mailing address:
  • Phone: 626-409-6656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number21207
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: