Provider Demographics
NPI:1174147888
Name:MESA, EVER ANSELMO (CHAPLAIN)
Entity type:Individual
Prefix:MR
First Name:EVER
Middle Name:ANSELMO
Last Name:MESA
Suffix:
Gender:M
Credentials:CHAPLAIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 189033
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-9033
Mailing Address - Country:US
Mailing Address - Phone:916-317-1952
Mailing Address - Fax:
Practice Address - Street 1:2710 GATEWAY OAKS DR STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-3505
Practice Address - Country:US
Practice Address - Phone:916-619-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral