Healthcare Provider Details

I. General information

NPI: 1003202300
Provider Name (Legal Business Name): DINA M MEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DINA MIROSLAVA MEZA ORTIZ FNP

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST HEAD AND NECK BOX 6
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

3754 W 135TH ST
HAWTHORNE CA
90250-6210
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-2741
  • Fax: 310-222-5518
Mailing address:
  • Phone: 310-462-2212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001698
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: