Provider Demographics
NPI:1316616485
Name:MEZA, MAIRA YOSELIN (PA)
Entity type:Individual
Prefix:
First Name:MAIRA
Middle Name:YOSELIN
Last Name:MEZA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-6821
Mailing Address - Country:US
Mailing Address - Phone:559-608-6581
Mailing Address - Fax:559-608-6582
Practice Address - Street 1:3425 N 1ST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-6821
Practice Address - Country:US
Practice Address - Phone:559-608-6581
Practice Address - Fax:559-608-6582
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA62298207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine