Provider Demographics
NPI:1053737221
Name:MESA, JUAN RAFAEL (MS, MS, MA)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:RAFAEL
Last Name:MESA
Suffix:
Gender:M
Credentials:MS, MS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2926 FOOTHILL BLVD
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2524
Mailing Address - Country:US
Mailing Address - Phone:917-862-2250
Mailing Address - Fax:
Practice Address - Street 1:2926 FOOTHILL BLVD
Practice Address - Street 2:APARTMENT 1
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2524
Practice Address - Country:US
Practice Address - Phone:917-862-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst