Provider Demographics
NPI:1427448661
Name:MESIKA(MESSICA), ETAHL MAYA (RN)
Entity type:Individual
Prefix:
First Name:ETAHL
Middle Name:MAYA
Last Name:MESIKA(MESSICA)
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 N VENTURA ST APT B
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2648
Mailing Address - Country:US
Mailing Address - Phone:360-306-1190
Mailing Address - Fax:
Practice Address - Street 1:315 CAMINO DEL REMEDIO RM 258
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1332
Practice Address - Country:US
Practice Address - Phone:360-306-1190
Practice Address - Fax:805-681-4747
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA827679163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse