Healthcare Provider Details

I. General information

NPI: 1093091191
Provider Name (Legal Business Name): CHARLOWE MESINA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2995 ROSSMORE WAY RM 15
SAN JOSE CA
95148-3527
US

IV. Provider business mailing address

PO BOX 53738
SAN JOSE CA
95153-0738
US

V. Phone/Fax

Practice location:
  • Phone: 408-608-8792
  • Fax:
Mailing address:
  • Phone: 408-768-9644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number26215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: