Provider Demographics
NPI:1093816803
Name:MESINA, SOPHELA MINOZA (MD)
Entity Type:Individual
Prefix:MISS
First Name:SOPHELA
Middle Name:MINOZA
Last Name:MESINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SOPHELA
Other - Middle Name:MINOZA
Other - Last Name:MESINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD INC
Mailing Address - Street 1:957 NORTH HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133
Mailing Address - Country:US
Mailing Address - Phone:937-393-4255
Mailing Address - Fax:937-393-4256
Practice Address - Street 1:957 NORTH HIGH STREET
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133
Practice Address - Country:US
Practice Address - Phone:937-393-4255
Practice Address - Fax:937-393-4256
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035995208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0217616Medicaid