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NPI Code Detail

MEDICARE: MS. VILMA MELINDA MEZA LAT

MEDICARE:  MS. VILMA MELINDA MEZA  LAT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerAT1177TX

General Provider Information

NPI Number : 1376669614
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. VILMA MELINDA MEZA LAT
Provider Business Mailing Address
First Line : 2509 FOREST AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76112-5519
Country : US
Telephone Number : 817-360-8601
Fax Number :
Provider Business Practice Location Address
First Line : 9100 MID CITIES BLVD
Second Line :
City : NORTH RICHLAND HILLS
State : TX
Zip : 76180-4800
Country : US
Telephone Number : 817-547-8000
Fax Number : 817-547-8393
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/08/2007

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Directions to “ MS. VILMA MELINDA MEZA LAT” Practice Location

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