Provider Demographics
NPI:1326353293
Name:MEZA, CELESTE C
Entity Type:Individual
Prefix:MISS
First Name:CELESTE
Middle Name:C
Last Name:MEZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 CLARENDON AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4119
Mailing Address - Country:US
Mailing Address - Phone:323-584-3700
Mailing Address - Fax:
Practice Address - Street 1:2629 CLARENDON AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4119
Practice Address - Country:US
Practice Address - Phone:323-584-3700
Practice Address - Fax:323-277-4674
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA698811041C0700X, 101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker