Healthcare Provider Details

I. General information

NPI: 1285181461
Provider Name (Legal Business Name): ANNETTE MEZA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 04/25/2024
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S MYRTLE AVE # 100
MONROVIA CA
91016-3406
US

IV. Provider business mailing address

11244 HYATTSVILLE ST
ADELANTO CA
92301-6134
US

V. Phone/Fax

Practice location:
  • Phone: 626-775-7888
  • Fax:
Mailing address:
  • Phone: 909-782-9026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12153253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: