Provider Demographics
NPI:1114974771
Name:MECHOSO, DENA (MD)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:MECHOSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DENA
Other - Middle Name:
Other - Last Name:NIEDZWIECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:133 N ALTADENA DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-7325
Mailing Address - Country:US
Mailing Address - Phone:626-397-8335
Mailing Address - Fax:626-397-8350
Practice Address - Street 1:301 E HUNTINGTON DR
Practice Address - Street 2:SUITE 320
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3747
Practice Address - Country:US
Practice Address - Phone:626-447-3516
Practice Address - Fax:626-447-8546
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90333208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH57590Medicare UPIN