Provider Demographics
NPI:1346302080
Name:MEZA, AIDA F (MD)
Entity Type:Individual
Prefix:DR
First Name:AIDA
Middle Name:F
Last Name:MEZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1254 FRANKLIN RAVEN PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7707
Mailing Address - Country:US
Mailing Address - Phone:915-261-7737
Mailing Address - Fax:
Practice Address - Street 1:1254 FRANKLIN RAVEN PL
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7707
Practice Address - Country:US
Practice Address - Phone:915-261-7737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5378207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM44223889Medicaid
TX8X1231OtherBCBS
TX186290601Medicaid
TX8J4857Medicare PIN