Provider Demographics
NPI:1346937125
Name:MEZA, ERIC RYAN
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:RYAN
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 1:825 E BETHANY HOME RD APT C130
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2138
Mailing Address - Country:US
Mailing Address - Phone:949-423-8331
Mailing Address - Fax:
Practice Address - Street 1:77 E COLUMBUS AVE STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2351
Practice Address - Country:US
Practice Address - Phone:602-248-4432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral