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Individual

KATHLEEN MEZOFF

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Taxonomy

Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
80-68
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10002105
LOVELACE HEALTH/SALUD
NM
05
13656
NM
05
239922
AZ
01
85031326887301A131
CHAMPUS
01
NM001861
BCBS
NM
01
PROVP14495
MOLINA
NM
Enumeration date
02/02/2006
Last updated
07/09/2007
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