Provider Demographics
NPI:1538052089
Name:MEZA-BACA, ANGELA AMANDA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:AMANDA
Last Name:MEZA-BACA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:AMANDA
Other - Last Name:BOLANOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 OCEAN AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3549
Mailing Address - Country:US
Mailing Address - Phone:559-741-3312
Mailing Address - Fax:
Practice Address - Street 1:700 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2815
Practice Address - Country:US
Practice Address - Phone:831-645-1261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6932F5F88C171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach