Basic Information
| Provider Information | |||||||||
| NPI: | 1144495128 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEZA | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | JUN | ||||||||
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| OtherLastName: | MEZA | ||||||||
| OtherFirstName: | RICHARD | ||||||||
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| OtherCredential: | N.P. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3339 WILLOWBROOK CIR | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952191707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2099575214 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1325 COTTONWOOD ST | ||||||||
| Address2: | |||||||||
| City: | WOODLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956955131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306623961 | ||||||||
| FaxNumber: | 5306689429 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2008 | ||||||||
| LastUpdateDate: | 09/12/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NP 17656 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.