Active NPI
David Mesa Jr.
- Medical Laboratory Technician
- Alhambra, CA
National Provider Identifier
1689084063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Laboratory Technician
- License
- 05D2065387
- Practice address
- 1104 S Garfield Ave Ste a
Alhambra, CA 91801-7803 - Phone
- (626) 872-2899
- Fax
- (626) 872-2892
- NPI assigned
- May 6, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Laboratory Technician | 246RM2200X | 05D2065387 | CA | Primary |
Addresses
Primary practice location
1104 S Garfield Ave Ste a
Alhambra, CA 91801-7803
Mailing address
1104 S Garfield Ave Ste a
Alhambra, CA 91801-7803
Phone (626) 872-2899
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05D2065387 | Other | CA | STATE LABORATORY LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05D2065387 | CA | MD | Medical Laboratory Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1399334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399334400000",
"number": "1689084063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1104 S GARFIELD AVE STE A",
"city": "ALHAMBRA",
"state": "CA",
"postal_code": "918017803",
"telephone_number": "626-872-2899",
"fax_number": "626-872-2892"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1104 S GARFIELD AVE STE A",
"city": "ALHAMBRA",
"state": "CA",
"postal_code": "918017803",
"telephone_number": "626-872-2899",
"fax_number": "626-872-2892"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MESA",
"first_name": "DAVID",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-05-06",
"last_updated": "2014-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "246RM2200X",
"taxonomy_group": "",
"desc": "Technician, Pathology, Medical Laboratory",
"state": "CA",
"license": "05D2065387",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LABORATORY LICENSE",
"identifier": "05D2065387",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Alhambra, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.