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General NPI Number Information
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NPI Number | 1679349377
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Entity Type | Individual
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Provider Name | MIGUEL ANGEL MESA
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Gender | Male
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Dates
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Enumeration Date | 12/04/2023
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 1675 LEAHY ST STE 210B
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City | MUSKEGON
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State | MI
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Zip | 49442-5542
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Country | US
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Telephone | 231-672-3201
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Fax | 231-672-8404
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Provider Business Mailing Address
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Address Line | 11390 N 24TH ST
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City | MONTAGUE
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State | MI
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Zip | 49437-9534
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Country | US
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Telephone | 616-238-6951
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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