Provider Demographics
NPI:1114466331
Name:MEZA, MARITZA (REGISTERED AMFT)
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:MEZA
Suffix:
Gender:F
Credentials:REGISTERED AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 BISSO LN STE 2002425
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4897
Mailing Address - Country:US
Mailing Address - Phone:925-839-3393
Mailing Address - Fax:925-646-5662
Practice Address - Street 1:401 S TUSTIN ST
Practice Address - Street 2:BUILDING D
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2550
Practice Address - Country:US
Practice Address - Phone:714-289-3936
Practice Address - Fax:714-289-3938
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119906106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist