Healthcare Provider Details

I. General information

NPI: 1366210429
Provider Name (Legal Business Name): ESPERANZA MEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NEEDHAM ST
MODESTO CA
95354-0730
US

IV. Provider business mailing address

1001 NEEDHAM ST
MODESTO CA
95354-0730
US

V. Phone/Fax

Practice location:
  • Phone: 209-569-0373
  • Fax: 209-529-8519
Mailing address:
  • Phone: 209-569-0373
  • Fax: 209-529-8519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: