Provider Demographics
NPI:1164765194
Name:MEZA, LUIS
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:MEZA
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 1:6344 PASCAL ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-1116
Mailing Address - Country:US
Mailing Address - Phone:915-496-5215
Mailing Address - Fax:915-219-7720
Practice Address - Street 1:6344 PASCAL ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-1116
Practice Address - Country:US
Practice Address - Phone:915-496-5215
Practice Address - Fax:915-219-7720
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLHOC1200349311ZA0620X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant