Healthcare Provider Details

I. General information

NPI: 1396660148
Provider Name (Legal Business Name): JOEL MEZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 ROCK ST
MOUNTAIN VIEW CA
94043-1810
US

IV. Provider business mailing address

644 MCKENZIE AVE
WATSONVILLE CA
95076-3507
US

V. Phone/Fax

Practice location:
  • Phone: 650-903-6945
  • Fax:
Mailing address:
  • Phone: 831-406-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number210181856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: