Provider Demographics
NPI:1568250900
Name:MEZA, DARLENE BRYANNA
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:BRYANNA
Last Name:MEZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 W CALLE PRIMERA APT G
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-2928
Mailing Address - Country:US
Mailing Address - Phone:619-513-1627
Mailing Address - Fax:
Practice Address - Street 1:178 W CALLE PRIMERA APT G
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92173-2928
Practice Address - Country:US
Practice Address - Phone:619-513-1627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-26
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT154014101YM0800X
CAPCC19061101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health