Healthcare Provider Details

I. General information

NPI: 1649292707
Provider Name (Legal Business Name): LUIS JAVIER MESA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E HALLANDALE BEACH BLVD STE 205A
HALLANDALE BEACH FL
33009-4634
US

IV. Provider business mailing address

1250 E HALLANDALE BEACH BLVD STE 205A
HALLANDALE BEACH FL
33009-4634
US

V. Phone/Fax

Practice location:
  • Phone: 954-544-5979
  • Fax: 954-404-7296
Mailing address:
  • Phone: 954-544-5979
  • Fax: 954-404-7296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME90288
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: