MEDICARE: GRISELDA MANI MEZA M.D.

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
1	208000000X	Pediatrics Physician	0101246974	VA
2	208000000X	Pediatrics Physician	N5869	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407150113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRISELDA MANI MEZA M.D.

Provider Business Mailing Address
First Line	:	2200 OPITZ BLVD STE 355
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-3340
Country	:	US
Telephone Number	:	703-580-6400
Fax Number	:	703-580-4550

Provider Business Practice Location Address
First Line	:	14009 MINNIEVILLE RD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2310
Country	:	US
Telephone Number	:	703-580-6400
Fax Number	:	703-580-6402

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2011
Last Update Date	:	11/04/2025

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Directions to “ GRISELDA MANI MEZA M.D.” Practice Location

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