Provider Demographics
NPI:1225202054
Name:MESA, FRANK RAY SR
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:RAY
Last Name:MESA
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:FRANK
Other - Middle Name:RAY
Other - Last Name:MESA
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:29325 KIMBERLINA RD.
Mailing Address - Street 2:
Mailing Address - City:WASCO
Mailing Address - State:CA
Mailing Address - Zip Code:93280-1000
Mailing Address - Country:US
Mailing Address - Phone:661-758-4029
Mailing Address - Fax:661-758-0891
Practice Address - Street 1:1021 4TH STREET
Practice Address - Street 2:STE B
Practice Address - City:TAFT
Practice Address - State:CA
Practice Address - Zip Code:93268
Practice Address - Country:US
Practice Address - Phone:661-765-7025
Practice Address - Fax:661-758-0891
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA010860315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)