1447278601 NPI number — MRS. TONI DANETTE DELA MEROT NP

Table of content: MRS. TONI DANETTE DELA MEROT NP (NPI 1447278601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447278601 NPI number — MRS. TONI DANETTE DELA MEROT NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEROT
Provider First Name:
TONI
Provider Middle Name:
DANETTE DELA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447278601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5855 OLIVAS PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VENTURA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93003-7672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-667-2801
Provider Business Mailing Address Fax Number:
805-667-2865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
242 E HARVARD BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SANTA PAULA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93060-3372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-525-9595
Provider Business Practice Location Address Fax Number:
805-525-6667
Provider Enumeration Date:
07/17/2006

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: 363LF0000X , with the licence number:  676386 NP16382 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: RHM18553H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT40394F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: RHM08609F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95-1683892 . This is a "OTHER INSURANCE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: RHM08608F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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