Provider Demographics
NPI:1194243832
Name:MESA, ALEJANDRO RICARDO
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:RICARDO
Last Name:MESA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ALEJANDRO
Other - Middle Name:RICARDO
Other - Last Name:MESA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1829 RUSHDEN DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-7708
Mailing Address - Country:US
Mailing Address - Phone:407-619-5088
Mailing Address - Fax:
Practice Address - Street 1:1715 PALM BEACH DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-2473
Practice Address - Country:US
Practice Address - Phone:407-889-2287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician