Healthcare Provider Details

I. General information

NPI: 1285158568
Provider Name (Legal Business Name): BLANCA ESTELA MEZA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 07/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 SAN ANTONIO DR NE
ALBUQUERQUE NM
87109-4873
US

IV. Provider business mailing address

4070B MERCURY CIR SE
ALBUQUERQUE NM
87116-3024
US

V. Phone/Fax

Practice location:
  • Phone: 915-820-3297
  • Fax:
Mailing address:
  • Phone: 915-820-3297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCNP-03304
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: