Healthcare Provider Details

I. General information

NPI: 1326670092
Provider Name (Legal Business Name): LIZA RENEE MEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7624 PAINTER AVE STE 100
WHITTIER CA
90602-2327
US

IV. Provider business mailing address

9033 BASE LINE RD STE N
RANCHO CUCAMONGA CA
91730-1215
US

V. Phone/Fax

Practice location:
  • Phone: 562-945-9333
  • Fax:
Mailing address:
  • Phone: 909-256-4870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number740630
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95016649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: