Healthcare Provider Details

I. General information

NPI: 1407150113
Provider Name (Legal Business Name): GRISELDA MANI MEZA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14009 MINNIEVILLE RD
WOODBRIDGE VA
22193-2310
US

IV. Provider business mailing address

2200 OPITZ BLVD STE 355
WOODBRIDGE VA
22191-3340
US

V. Phone/Fax

Practice location:
  • Phone: 703-580-6400
  • Fax: 703-580-6402
Mailing address:
  • Phone: 703-580-6400
  • Fax: 703-580-4550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101246974
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN5869
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: