Provider Demographics
NPI:1841773090
Name:MEZA, JAIME ALBERTO JR
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:ALBERTO
Last Name:MEZA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 IVANA CT
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-4508
Mailing Address - Country:US
Mailing Address - Phone:956-206-9237
Mailing Address - Fax:
Practice Address - Street 1:1200 E LANE ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-7299
Practice Address - Country:US
Practice Address - Phone:956-722-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2094502225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant