Provider Demographics
NPI:1750035689
Name:MEZA, OLIVIA GABRIELLA (RD)
Entity Type:Individual
Prefix:MISS
First Name:OLIVIA
Middle Name:GABRIELLA
Last Name:MEZA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 E DEVONSHIRE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3033
Mailing Address - Country:US
Mailing Address - Phone:951-330-3110
Mailing Address - Fax:
Practice Address - Street 1:26199 GRANT AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-6727
Practice Address - Country:US
Practice Address - Phone:951-852-3508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered