Provider Demographics
NPI:1114356912
Name:MESA, IRMA MARUGENIA
Entity Type:Individual
Prefix:MISS
First Name:IRMA
Middle Name:MARUGENIA
Last Name:MESA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9247 SW 154TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1127
Mailing Address - Country:US
Mailing Address - Phone:305-562-9885
Mailing Address - Fax:
Practice Address - Street 1:9247 SW 154TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1127
Practice Address - Country:US
Practice Address - Phone:305-562-9885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM200413928420390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program