Healthcare Provider Details

I. General information

NPI: 1508544636
Provider Name (Legal Business Name): MARY MECCA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14589 S BASCOM AVE
LOS GATOS CA
95032-2026
US

IV. Provider business mailing address

14589 S BASCOM AVE
LOS GATOS CA
95032-2026
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-7438
  • Fax:
Mailing address:
  • Phone: 408-356-7438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: