Provider Demographics
NPI:1063592269
Name:MEZA, CARLOS ROBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ROBERTO
Last Name:MEZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S ATLANTIC BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-6340
Mailing Address - Country:US
Mailing Address - Phone:323-888-1366
Mailing Address - Fax:323-888-0600
Practice Address - Street 1:1900 S ATLANTIC BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-6340
Practice Address - Country:US
Practice Address - Phone:323-888-1366
Practice Address - Fax:323-888-0600
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52121207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A521210Medicaid
CAA52121AMedicare ID - Type Unspecified
CA00A521210Medicaid