Provider Demographics
NPI:1477308617
Name:MEZA, CAROLINA PATRICIA
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:PATRICIA
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 1:13918 SMILING DAISY PL
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-4402
Mailing Address - Country:US
Mailing Address - Phone:786-681-4314
Mailing Address - Fax:
Practice Address - Street 1:13918 SMILING DAISY PL
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-4402
Practice Address - Country:US
Practice Address - Phone:786-681-4314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-335702106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician