Healthcare Provider Details

I. General information

NPI: 1528093101
Provider Name (Legal Business Name): ALLEN KAISLER-MEZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1688 WILLOW ST STE D
SAN JOSE CA
95125-5109
US

IV. Provider business mailing address

1688 WILLOW ST STE D
SAN JOSE CA
95125-5109
US

V. Phone/Fax

Practice location:
  • Phone: 408-264-5570
  • Fax: 408-264-5576
Mailing address:
  • Phone: 408-264-5570
  • Fax: 408-264-5576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberG74906
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberG74906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: