Provider Demographics
NPI:1649292707
Name:MESA, LUIS JAVIER (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:JAVIER
Last Name:MESA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21110 BISCAYNE BOULEVARD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1227
Mailing Address - Country:US
Mailing Address - Phone:305-937-4400
Mailing Address - Fax:305-931-5625
Practice Address - Street 1:21110 BISCAYNE BOULEVARD
Practice Address - Street 2:SUITE 405
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1227
Practice Address - Country:US
Practice Address - Phone:305-937-4400
Practice Address - Fax:305-931-5625
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOME0090288174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274475900Medicaid
FL274475900Medicaid
FLH33993Medicare UPIN