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General NPI Number Information
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NPI Number | 1528402005
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Entity Type | Organization
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Legal Business Name | CARLOS R MEZA MD INC
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Dates
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Enumeration Date | 04/26/2013
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Last Update Date | 04/26/2013
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Provider Practice Location Address
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Address Line | 1900 S ATLANTIC BLVD SUITE 3
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City | MONTEREY PARK
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State | CA
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Zip | 91754-6340
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Country | US
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Telephone | 323-888-1366
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Fax | 323-888-0600
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Provider Business Mailing Address
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Address Line | PO BOX 92710
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City | CITY OF INDUSTRY
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State | CA
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Zip | 91715-2710
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Country | US
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Telephone | 323-888-1366
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Fax | 323-888-0600
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARLOS MEZA
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Credential | MD
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Telephone | 323-888-1366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A52121
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License Number State | CA
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