Healthcare Provider Details

I. General information

NPI: 1124329073
Provider Name (Legal Business Name): ELIZABETH MEZA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6066 ROCK ST
SAN DIEGO CA
92115-6632
US

IV. Provider business mailing address

6066 ROCK ST
SAN DIEGO CA
92115-6632
US

V. Phone/Fax

Practice location:
  • Phone: 619-549-6794
  • Fax: 619-265-5807
Mailing address:
  • Phone: 619-549-6794
  • Fax: 619-265-5807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW 25169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: