Provider Demographics
NPI:1043499775
Name:JANINE C MEZA MD PROFESSIONAL LLC
Entity Type:Organization
Organization Name:JANINE C MEZA MD PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-226-7400
Mailing Address - Street 1:1601 E 19TH AVE STE 3650
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1282
Mailing Address - Country:US
Mailing Address - Phone:303-226-7400
Mailing Address - Fax:303-839-7795
Practice Address - Street 1:1601 E 19TH AVE STE 3650
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1282
Practice Address - Country:US
Practice Address - Phone:303-226-7400
Practice Address - Fax:303-226-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35349208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000153189Medicaid
CO97339849Medicaid
COG27899Medicare UPIN