Provider Demographics
NPI:1104979269
Name:MESOLA, ROMMEL PAULO (MD)
Entity type:Individual
Prefix:
First Name:ROMMEL
Middle Name:PAULO
Last Name:MESOLA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20751 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-7893
Mailing Address - Country:US
Mailing Address - Phone:623-463-5000
Mailing Address - Fax:
Practice Address - Street 1:20751 W MARKET ST
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-7893
Practice Address - Country:US
Practice Address - Phone:623-463-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50495207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8466559Medicaid
WA8466559Medicaid
WAG8865271Medicare PIN