Provider Demographics
NPI:1659403285
Name:MEZA, GEORGE JESUS (LCSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JESUS
Last Name:MEZA
Suffix:
Gender:M
Credentials:LCSW, PHD
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 97
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-0097
Mailing Address - Country:US
Mailing Address - Phone:310-978-9495
Mailing Address - Fax:310-978-0978
Practice Address - Street 1:14623 HAWTHORNE BLVD STE 406
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1595
Practice Address - Country:US
Practice Address - Phone:310-978-9495
Practice Address - Fax:310-978-9495
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28943103TC0700X
CALCS163051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty