Provider Demographics
NPI:1083895536
Name:MEZA-VALENCIA, CARLOS J
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:J
Last Name:MEZA-VALENCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 SW 1ST AVE STE 838
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-4520
Mailing Address - Country:US
Mailing Address - Phone:571-244-4684
Mailing Address - Fax:888-356-1032
Practice Address - Street 1:936 SW 1ST AVE STE 838
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-4520
Practice Address - Country:US
Practice Address - Phone:571-244-4684
Practice Address - Fax:888-356-1032
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical