Provider Demographics
NPI:1538812151
Name:MEZQUIA, THALIA
Entity type:Individual
Prefix:
First Name:THALIA
Middle Name:
Last Name:MEZQUIA
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 1:1800 79TH STREET CSWY APT A203
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4226
Mailing Address - Country:US
Mailing Address - Phone:786-439-7454
Mailing Address - Fax:
Practice Address - Street 1:18500 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-2427
Practice Address - Country:US
Practice Address - Phone:786-493-7454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT101563183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician