Provider Demographics
NPI:1801937206
Name:D'MEZA, RUTH (BA)
Entity type:Individual
Prefix:MS
First Name:RUTH
Middle Name:
Last Name:D'MEZA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 NW 14TH ST
Mailing Address - Street 2:UNIVERSITY OF MIAMI EARLY STEPS
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2107
Mailing Address - Country:US
Mailing Address - Phone:305-243-5600
Mailing Address - Fax:305-243-4595
Practice Address - Street 1:1601 NW 12TH AVE
Practice Address - Street 2:UNIVERSITY OF MIAMI EARLY STEPS
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-243-5600
Practice Address - Fax:305-243-4595
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC2200X, 104100000X
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003592300Medicaid
FL757884900Medicaid