Provider Demographics
NPI:1588143648
Name:MERINO, J.REFUGIO GIOVANI (RDA)
Entity type:Individual
Prefix:
First Name:J.REFUGIO
Middle Name:GIOVANI
Last Name:MERINO
Suffix:
Gender:M
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S ALVARADO ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3345
Mailing Address - Country:US
Mailing Address - Phone:213-259-0606
Mailing Address - Fax:
Practice Address - Street 1:600 S ALVARADO ST STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3345
Practice Address - Country:US
Practice Address - Phone:213-259-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83243126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant