Healthcare Provider Details

I. General information

NPI: 1104880822
Provider Name (Legal Business Name): VERONICA MESQUIDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E 1ST ST STE. 203
DULUTH MN
55805-2297
US

IV. Provider business mailing address

1000 E 1ST ST STE. 203
DULUTH MN
55805-2297
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-6960
  • Fax: 218-249-6969
Mailing address:
  • Phone: 218-249-6960
  • Fax: 218-249-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number58120
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: