Provider Demographics
NPI:1326670092
Name:MEZA, LIZA RENEE
Entity type:Individual
Prefix:
First Name:LIZA
Middle Name:RENEE
Last Name:MEZA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9033 BASE LINE RD STE N
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1215
Mailing Address - Country:US
Mailing Address - Phone:909-256-4870
Mailing Address - Fax:
Practice Address - Street 1:7624 PAINTER AVE STE 100
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2327
Practice Address - Country:US
Practice Address - Phone:562-945-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA740630163W00000X
CA95016649363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse