Provider Demographics
NPI:1386509982
Name:MEZA, ROSA
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:MEZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32921 WILDOMAR RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4671
Mailing Address - Country:US
Mailing Address - Phone:951-285-4043
Mailing Address - Fax:
Practice Address - Street 1:32921 WILDOMAR RD
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4671
Practice Address - Country:US
Practice Address - Phone:951-285-4043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-17
Last Update Date:2025-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230110756103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool