Provider Demographics
NPI:1528402005
Name:CARLOS R MEZA MD INC
Entity Type:Organization
Organization Name:CARLOS R MEZA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MEZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-888-1366
Mailing Address - Street 1:PO BOX 92710
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91715-2710
Mailing Address - Country:US
Mailing Address - Phone:323-888-1366
Mailing Address - Fax:323-888-0600
Practice Address - Street 1:1900 S ATLANTIC BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-6340
Practice Address - Country:US
Practice Address - Phone:323-888-1366
Practice Address - Fax:323-888-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52121207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty