Provider Demographics
NPI:1962070839
Name:MEZA, MARIA DE LOS ANGELES (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DE LOS ANGELES
Last Name:MEZA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1250 E CLIFF DR STE 3E
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4847
Mailing Address - Country:US
Mailing Address - Phone:915-626-5548
Mailing Address - Fax:915-626-5411
Practice Address - Street 1:1250 E CLIFF DR STE 3E
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4847
Practice Address - Country:US
Practice Address - Phone:915-626-5548
Practice Address - Fax:915-626-5411
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1044444363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty