Provider Demographics
NPI:1235425711
Name:MESA, KIRE (MM)
Entity Type:Individual
Prefix:
First Name:KIRE
Middle Name:
Last Name:MESA
Suffix:
Gender:F
Credentials:MM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3971 SW 8TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2937
Mailing Address - Country:US
Mailing Address - Phone:305-569-0266
Mailing Address - Fax:305-569-0267
Practice Address - Street 1:3971 SW 8TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2937
Practice Address - Country:US
Practice Address - Phone:305-569-0266
Practice Address - Fax:305-569-0267
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA61948225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist