Provider Demographics
NPI:1730104761
Name:MEZA, CARLOS E (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:E
Last Name:MEZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 N CALIFORNIA ST STE 202
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6032
Mailing Address - Country:US
Mailing Address - Phone:209-944-9063
Mailing Address - Fax:209-944-9339
Practice Address - Street 1:1805 N CALIFORNIA ST STE 202
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6032
Practice Address - Country:US
Practice Address - Phone:209-944-9063
Practice Address - Fax:209-944-9339
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31428207R00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A314282Medicare ID - Type Unspecified
CAA26475Medicare UPIN