Provider Demographics
NPI:1609252782
Name:MEZA, VERENICE O (SLP)
Entity Type:Individual
Prefix:
First Name:VERENICE
Middle Name:O
Last Name:MEZA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 E DIMONDALE DR
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-2917
Mailing Address - Country:US
Mailing Address - Phone:562-544-7508
Mailing Address - Fax:
Practice Address - Street 1:1726 E DIMONDALE DR
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-2917
Practice Address - Country:US
Practice Address - Phone:562-544-7508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28048235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist