Provider Demographics
NPI:1154897510
Name:MERINO, LUIS
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:MERINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16686 NW 21ST ST APT 11-303
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1884
Mailing Address - Country:US
Mailing Address - Phone:305-917-5919
Mailing Address - Fax:
Practice Address - Street 1:1400 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-6034
Practice Address - Country:US
Practice Address - Phone:305-915-8900
Practice Address - Fax:305-392-1391
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS101006171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCBHCM102648OtherCBHCM