Healthcare Provider Details

I. General information

NPI: 1780486365
Provider Name (Legal Business Name): VICTORIA MEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1196 W SOUTH JORDAN PKWY STE D2
SOUTH JORDAN UT
84095-4604
US

IV. Provider business mailing address

8977 S 1300 W # 2029
WEST JORDAN UT
84088-9274
US

V. Phone/Fax

Practice location:
  • Phone: 385-533-9590
  • Fax: 385-446-0039
Mailing address:
  • Phone: 385-533-9590
  • Fax: 385-446-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14252100-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: