Provider Demographics
NPI:1376669614
Name:MEZA, VILMA MELINDA (LAT)
Entity Type:Individual
Prefix:MS
First Name:VILMA
Middle Name:MELINDA
Last Name:MEZA
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-5519
Mailing Address - Country:US
Mailing Address - Phone:817-360-8601
Mailing Address - Fax:
Practice Address - Street 1:9100 MID CITIES BLVD
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-4800
Practice Address - Country:US
Practice Address - Phone:817-547-8000
Practice Address - Fax:817-547-8393
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT11772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer