Provider Demographics
NPI:1942563150
Name:MESA, NATHALIA (MD)
Entity Type:Individual
Prefix:
First Name:NATHALIA
Middle Name:
Last Name:MESA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11603 BLUEBIRD PL
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-2622
Mailing Address - Country:US
Mailing Address - Phone:941-870-4440
Mailing Address - Fax:941-870-2568
Practice Address - Street 1:3645 CORTEZ RD W STE 110
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3161
Practice Address - Country:US
Practice Address - Phone:888-795-2661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA131843207Q00000X
FLME144989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine