Healthcare Provider Details

I. General information

NPI: 1467716274
Provider Name (Legal Business Name): HATEM MEZHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 SHEPARD DR STE 103
SANTA MARIA CA
93454-7016
US

IV. Provider business mailing address

1505 SHEPARD DR STE 103
SANTA MARIA CA
93454-7016
US

V. Phone/Fax

Practice location:
  • Phone: 718-613-4000
  • Fax: 805-862-4196
Mailing address:
  • Phone: 718-613-4000
  • Fax: 805-862-4196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA134355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: