Provider Demographics
NPI:1932632122
Name:MESA VALDES, ANISLEIDYS
Entity type:Individual
Prefix:
First Name:ANISLEIDYS
Middle Name:
Last Name:MESA VALDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W 74TH ST APT 104
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4725
Mailing Address - Country:US
Mailing Address - Phone:786-468-3741
Mailing Address - Fax:305-901-1797
Practice Address - Street 1:850 W 74TH ST APT 104
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4725
Practice Address - Country:US
Practice Address - Phone:786-468-3741
Practice Address - Fax:305-901-1797
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician