Provider Demographics
NPI:1497628564
Name:MEZA ALCANTARA, VICTOR JR
Entity type:Individual
Prefix:
First Name:VICTOR JR
Middle Name:
Last Name:MEZA ALCANTARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-1518
Mailing Address - Country:US
Mailing Address - Phone:323-381-8163
Mailing Address - Fax:
Practice Address - Street 1:1150 S OLIVE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-2211
Practice Address - Country:US
Practice Address - Phone:213-712-5155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No251B00000XAgenciesCase Management