Provider Demographics
NPI:1396064408
Name:DE MESA, CHARLES JOHN (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOHN
Last Name:DE MESA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4860 Y ST STE 3020
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-7246
Mailing Address - Fax:916-734-5033
Practice Address - Street 1:4860 Y ST STE 3020
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-7246
Practice Address - Fax:916-734-5033
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A13238207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology