Provider Demographics
NPI:1952600926
Name:MESA, VIRGINIA Y (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:Y
Last Name:MESA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 CAMP RD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-3709
Mailing Address - Country:US
Mailing Address - Phone:321-634-6092
Mailing Address - Fax:
Practice Address - Street 1:855 CAMP RD
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-3709
Practice Address - Country:US
Practice Address - Phone:321-634-6092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 75065208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice