Healthcare Provider Details

I. General information

NPI: 1356814578
Provider Name (Legal Business Name): LUISA MESA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4932 NW 179TH TER
MIAMI GARDENS FL
33055-3248
US

IV. Provider business mailing address

4932 NEW 179TH TER
MIAMI GARDENS FL
33055
US

V. Phone/Fax

Practice location:
  • Phone: 786-956-4270
  • Fax:
Mailing address:
  • Phone: 786-956-4270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF04260295
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: