Provider Demographics
NPI:1447667910
Name:MESTAS, DENNIS JOSEPH (ATC)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:JOSEPH
Last Name:MESTAS
Suffix:
Gender:M
Credentials:ATC
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Mailing Address - Street 1:5800 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY GLEN
Mailing Address - State:CA
Mailing Address - Zip Code:91401-4062
Mailing Address - Country:US
Mailing Address - Phone:818-778-5540
Mailing Address - Fax:818-947-2560
Practice Address - Street 1:5800 FULTON AVE
Practice Address - Street 2:
Practice Address - City:VALLEY GLEN
Practice Address - State:CA
Practice Address - Zip Code:91401-4062
Practice Address - Country:US
Practice Address - Phone:818-778-5540
Practice Address - Fax:818-947-2560
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2255A2300XOtherATHLETIC TRAINING