Provider Demographics
NPI:1477630994
Name:MEZQUITA, ELVA RUTH (MD)
Entity Type:Individual
Prefix:
First Name:ELVA RUTH
Middle Name:
Last Name:MEZQUITA
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 1:18250 ROSCOE BLVD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4226
Mailing Address - Country:US
Mailing Address - Phone:818-341-3800
Mailing Address - Fax:818-341-3810
Practice Address - Street 1:18250 ROSCOE BLVD
Practice Address - Street 2:SUITE 245
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4226
Practice Address - Country:US
Practice Address - Phone:818-341-3800
Practice Address - Fax:818-341-3810
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA221182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA22118Medicare ID - Type Unspecified
CAF51192Medicare UPIN