1780966648 NPI number — MS. JOCELYN VERONICA MERINO S.W

Table of content: MS. JOCELYN VERONICA MERINO S.W (NPI 1780966648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780966648 NPI number — MS. JOCELYN VERONICA MERINO S.W

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERINO
Provider First Name:
JOCELYN
Provider Middle Name:
VERONICA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
S.W
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MERINO
Provider Other First Name:
JOCELYN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
JOCELYN MERINO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780966648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 JEFFERSON BLVD STE B195
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95605-2350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-403-2970
Provider Business Mailing Address Fax Number:
530-204-5255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 JEFFERSON BLVD STE B195
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95605-2350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-403-2970
Provider Business Practice Location Address Fax Number:
530-204-5255
Provider Enumeration Date:
09/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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