Healthcare Provider Details

I. General information

NPI: 1851084727
Provider Name (Legal Business Name): STANLEY FERNANDO MESEN PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 ALMADEN BLVD STE 600
SAN JOSE CA
95113-1605
US

IV. Provider business mailing address

5228 VANTAGE AVE APT 5
VALLEY VILLAGE CA
91607-5017
US

V. Phone/Fax

Practice location:
  • Phone: 256-500-8688
  • Fax: 855-670-7900
Mailing address:
  • Phone: 323-304-9855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95025013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: