Provider Demographics
NPI:1124816137
Name:MERLO, CITLALLY M
Entity type:Individual
Prefix:
First Name:CITLALLY
Middle Name:M
Last Name:MERLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13450 HIGHWAY 8 BUSINESS SPC 88
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-5204
Mailing Address - Country:US
Mailing Address - Phone:619-616-1411
Mailing Address - Fax:
Practice Address - Street 1:7592 METROPOLITAN DR STE 404
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4428
Practice Address - Country:US
Practice Address - Phone:619-376-6653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician