Provider Demographics
NPI:1710221866
Name:MESA, CATALINA
Entity Type:Individual
Prefix:
First Name:CATALINA
Middle Name:
Last Name:MESA
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 1:8249 NW 36TH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6673
Mailing Address - Country:US
Mailing Address - Phone:305-310-7907
Mailing Address - Fax:786-472-5447
Practice Address - Street 1:8249 NW 36TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6673
Practice Address - Country:US
Practice Address - Phone:305-310-7907
Practice Address - Fax:786-472-5447
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program