Healthcare Provider Details

I. General information

NPI: 1144495128
Provider Name (Legal Business Name): RICHARD JUN MEZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RICHARD MEZA N.P.

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 COTTONWOOD ST
WOODLAND CA
95695-5131
US

IV. Provider business mailing address

3339 WILLOWBROOK CIR
STOCKTON CA
95219-1707
US

V. Phone/Fax

Practice location:
  • Phone: 530-662-3961
  • Fax: 530-668-9429
Mailing address:
  • Phone: 209-957-5214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP 17656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: