Provider Demographics
NPI:1689336281
Name:MEZA, ISABEL ALDRETE
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:ALDRETE
Last Name:MEZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9620 CHESAPEAKE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1324
Mailing Address - Country:US
Mailing Address - Phone:858-505-9083
Mailing Address - Fax:
Practice Address - Street 1:360 OXFORD ST APT 2
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-3129
Practice Address - Country:US
Practice Address - Phone:619-289-6632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician