Provider Demographics
NPI:1922315720
Name:MEZA, ESTELA (LMP)
Entity Type:Individual
Prefix:
First Name:ESTELA
Middle Name:
Last Name:MEZA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12652 NE 157TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-7950
Mailing Address - Country:US
Mailing Address - Phone:206-697-5057
Mailing Address - Fax:
Practice Address - Street 1:17220 127TH PL NE STE 101A
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-7965
Practice Address - Country:US
Practice Address - Phone:206-697-5057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018435225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0175759OtherLABOR AND INDUSTRIES