Healthcare Provider Details

I. General information

NPI: 1538052089
Provider Name (Legal Business Name): ANGELA AMANDA MEZA-BACA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA AMANDA BOLANOS

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PACIFIC ST
MONTEREY CA
93940-2815
US

IV. Provider business mailing address

555 OCEAN AVE APT 16
MONTEREY CA
93940-3549
US

V. Phone/Fax

Practice location:
  • Phone: 831-645-1261
  • Fax:
Mailing address:
  • Phone: 559-741-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number6932F5F88C
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: