Provider Demographics
NPI:1912210204
Name:MESA, MELVIN JOCSON
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:JOCSON
Last Name:MESA
Suffix:
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 1:639 MARSAT CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-4678
Mailing Address - Country:US
Mailing Address - Phone:619-423-2600
Mailing Address - Fax:619-423-2681
Practice Address - Street 1:639 MARSAT CT
Practice Address - Street 2:SUITE B
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-4678
Practice Address - Country:US
Practice Address - Phone:619-423-2600
Practice Address - Fax:619-423-2681
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BX2000X
CA332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies