Healthcare Provider Details

I. General information

NPI: 1588346100
Provider Name (Legal Business Name): IWONA KIRSTY MESA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11NE 204TH STREET APT #26
MIAMI GARDENS FL
33179
US

IV. Provider business mailing address

227 SW 36TH AVE
MIAMI FL
33135-1018
US

V. Phone/Fax

Practice location:
  • Phone: 786-318-7812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-273300
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: