Healthcare Provider Details

I. General information

NPI: 1891133658
Provider Name (Legal Business Name): DANIEL MARC LEME MEZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 ZONAL AVE # IRD111
LOS ANGELES CA
90089-0121
US

IV. Provider business mailing address

2020 ZONAL AVE # IRD111
LOS ANGELES CA
90033
US

V. Phone/Fax

Practice location:
  • Phone: 206-859-8201
  • Fax:
Mailing address:
  • Phone: 206-859-8201
  • Fax: 323-226-5692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME128704
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC187009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: