MEDICARE: ANGELICA MEZA

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	225X00000X	Occupational Therapist	OT 6742	CA

General Provider Information

NPI Number	:	1770609455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELICA MEZA

Provider Business Mailing Address
First Line	:	1018 JANETTE ST
Second Line	:	HACIENDA HEIGHTS
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-1207
Country	:	US
Telephone Number	:	626-419-4241
Fax Number	:

Provider Business Practice Location Address
First Line	:	1018 JANETTE ST
Second Line	:	HACIENDA HEIGHTS
City	:	HACIENDA HEIGHTS
State	:	CA
Zip	:	91745-1207
Country	:	US
Telephone Number	:	626-419-4241
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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