Provider Demographics
NPI:1194445130
Name:MEZA, YICEL
Entity type:Individual
Prefix:
First Name:YICEL
Middle Name:
Last Name:MEZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18071 BENEDA LN APT 210
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-5417
Mailing Address - Country:US
Mailing Address - Phone:818-477-7055
Mailing Address - Fax:
Practice Address - Street 1:18071 BENEDA LN APT 210
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-5417
Practice Address - Country:US
Practice Address - Phone:818-477-7055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator