Provider Demographics
NPI:1710767827
Name:MEAZA, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MEAZA
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 1:111 E COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:OCCOQUAN
Mailing Address - State:VA
Mailing Address - Zip Code:22125-7701
Mailing Address - Country:US
Mailing Address - Phone:571-300-5228
Mailing Address - Fax:
Practice Address - Street 1:111 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:OCCOQUAN
Practice Address - State:VA
Practice Address - Zip Code:22125-7701
Practice Address - Country:US
Practice Address - Phone:571-300-5228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA258223246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory