Provider Demographics
NPI:1639905573
Name:MESA ROY, JOSE ALEJANDRO
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ALEJANDRO
Last Name:MESA ROY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6533 EMERALD DUNES DR APT 303
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-2772
Mailing Address - Country:US
Mailing Address - Phone:305-984-9014
Mailing Address - Fax:
Practice Address - Street 1:6533 EMERALD DUNES DR APT 303
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-2772
Practice Address - Country:US
Practice Address - Phone:305-984-9014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-376037106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician