Provider Demographics
NPI:1417793506
Name:MEZA, KAYLA
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
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 1:1208 ESTON ST
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-4814
Mailing Address - Country:US
Mailing Address - Phone:805-765-0554
Mailing Address - Fax:
Practice Address - Street 1:313 LENNON LN STE 100
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2460
Practice Address - Country:US
Practice Address - Phone:925-465-1585
Practice Address - Fax:925-433-6555
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician