Provider Demographics
NPI:1366108714
Name:MESA, ANDREINA (CSFA)
Entity type:Individual
Prefix:
First Name:ANDREINA
Middle Name:
Last Name:MESA
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:ANDREINA
Other - Middle Name:
Other - Last Name:MESA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:496 SPANISH TRACE DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-6004
Mailing Address - Country:US
Mailing Address - Phone:321-914-8530
Mailing Address - Fax:
Practice Address - Street 1:601 EAST ALTA DRIVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701
Practice Address - Country:US
Practice Address - Phone:321-914-8530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL206088156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Multi-Specialty