Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95001698 | CA |
NPI | 1003202300 |
---|---|
Provider Name | Dina M Meza |
First Address | Hawthorne, CA 90250-6210 |
Second Address | Torrance, CA 90502-2004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2015 |
Last Update Date | 13/04/2015 |