MEDICARE: MR. DENNIS JOSEPH MESTAS ATC

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	2255A2300X	Athletic Trainer

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2255A2300X	OTHER	CA	ATHLETIC TRAINING

General Provider Information

NPI Number	:	1447667910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENNIS JOSEPH MESTAS ATC

Provider Business Mailing Address
First Line	:	5800 FULTON AVE
Second Line	:
City	:	VALLEY GLEN
State	:	CA
Zip	:	91401-4062
Country	:	US
Telephone Number	:	818-778-5540
Fax Number	:	818-947-2560

Provider Business Practice Location Address
First Line	:	5800 FULTON AVE
Second Line	:
City	:	VALLEY GLEN
State	:	CA
Zip	:	91401-4062
Country	:	US
Telephone Number	:	818-778-5540
Fax Number	:	818-947-2560

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

Provider Enumeration Date	:	07/16/2014
Last Update Date	:	07/16/2014

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