MEDICARE: MARTHA A. MEZA MD

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	207R00000X	Internal Medicine Physician	A80538	CA

General Provider Information

NPI Number	:	1629126545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA A. MEZA MD

Provider Business Mailing Address
First Line	:	4623 EAGLE ROCK BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-3049
Country	:	US
Telephone Number	:	323-340-1500
Fax Number	:	323-340-1511

Provider Business Practice Location Address
First Line	:	4623 EAGLE ROCK BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-3049
Country	:	US
Telephone Number	:	323-340-1500
Fax Number	:	323-340-1511

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	01/17/2014

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