Provider Demographics
NPI:1467716274
Name:MEZHER, HATEM
Entity Type:Individual
Prefix:
First Name:HATEM
Middle Name:
Last Name:MEZHER
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 1:1505 SHEPARD DR STE 103
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7016
Mailing Address - Country:US
Mailing Address - Phone:718-613-4000
Mailing Address - Fax:805-862-4196
Practice Address - Street 1:1505 SHEPARD DR STE 103
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7016
Practice Address - Country:US
Practice Address - Phone:718-613-4000
Practice Address - Fax:805-862-4196
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA134355207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology