Provider Demographics
NPI:1154026136
Name:MEZA, ALBERT VINCENT (EDD)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:VINCENT
Last Name:MEZA
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6529 ALTA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-1515
Mailing Address - Country:US
Mailing Address - Phone:510-637-9452
Mailing Address - Fax:
Practice Address - Street 1:2601 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3130
Practice Address - Country:US
Practice Address - Phone:628-333-9050
Practice Address - Fax:415-648-6291
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15981103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist