Basic Information
| Provider Information | |||||||||
| NPI: | 1205964210 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEZA | ||||||||
| FirstName: | EVONNE | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | IMF | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RAMOS | ||||||||
| OtherFirstName: | EVONNE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherNameSuffix: | |||||||||
| OtherCredential: | BA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4317 SAN MARTIN DR | ||||||||
| Address2: | |||||||||
| City: | SALIDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593000360 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 900 CORPORATE CENTER DR | ||||||||
| Address2: | |||||||||
| City: | MONTEREY PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917547620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235264016 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | IMF99209 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.