Provider Demographics
NPI:1508997511
Name:MEZA, FAUSTO SANTIAGO (MD MPA)
Entity Type:Individual
Prefix:
First Name:FAUSTO
Middle Name:SANTIAGO
Last Name:MEZA
Suffix:
Gender:M
Credentials:MD MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 531768
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-1768
Mailing Address - Country:US
Mailing Address - Phone:956-364-0482
Mailing Address - Fax:956-364-1255
Practice Address - Street 1:2101 PEASE ST
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8307
Practice Address - Country:US
Practice Address - Phone:956-364-0482
Practice Address - Fax:956-364-1255
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22902201207R00000X
TXM7431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J8557Medicare PIN