Provider Demographics
NPI:1164991972
Name:MEZA-VALLE, OSCAR MANUAL
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:MANUAL
Last Name:MEZA-VALLE
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 1:12812 101ST AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-9101
Mailing Address - Country:US
Mailing Address - Phone:253-864-4770
Mailing Address - Fax:
Practice Address - Street 1:12812 101ST AVENUE CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-9101
Practice Address - Country:US
Practice Address - Phone:253-864-4770
Practice Address - Fax:253-864-4771
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60889560171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator