Healthcare Provider Details

I. General information

NPI: 1184913477
Provider Name (Legal Business Name): MR. ANASTACIO S MEZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8433 HARRION DR
INDIANAPOLIS IN
46226-2034
US

IV. Provider business mailing address

PO BOX 50527
INDIANAPOLIS IN
46250-0527
US

V. Phone/Fax

Practice location:
  • Phone: 317-363-6827
  • Fax: 317-641-3913
Mailing address:
  • Phone: 317-363-6827
  • Fax: 317-641-3913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: