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General NPI Number Information
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NPI Number | 1649988007
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Entity Type | Individual
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Provider Name | LEIDY DIANA C MEZA RODRIGUEZ DDS
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Gender | Female
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 1344 W CLINTON AVE
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City | FRESNO
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State | CA
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Zip | 93705-3805
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Country | US
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Telephone | 559-737-4710
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 STOCKER ST APT 29
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City | VIEW PARK
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State | CA
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Zip | 90008-5121
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Country | US
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Telephone | 442-230-2041
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019033990
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License Number State | IL
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