| Doctor Name: | DR. ELIZABETH DOMINIQUE MESA |
| NPI Number: | 1841405719 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSYD |
| License Number: | PY7372 |
| Business Practice Address: | 19000 Sw 377th St Florida City, FL - 330346409 |
| Business Phone Number: | 3052421848 |
| Business Fax Number: | |
| Mailing Address: | 4945 Sw 140th Ct, MIAMI |
| State: | FL |
| Postal Code: | 331754813 |
| Phone Number: | 3055276006 |
| Fax Number: | |
| NPI Enumeration Date: | 05/13/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PY7372 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |