MEDICARE: J.REFUGIO GIOVANI MERINO RDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	126800000X	Dental Assistant	83243	CA

General Provider Information

NPI Number	:	1588143648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	J.REFUGIO GIOVANI MERINO RDA

Provider Business Mailing Address
First Line	:	600 S ALVARADO ST STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3345
Country	:	US
Telephone Number	:	213-259-0606
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 S ALVARADO ST STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3345
Country	:	US
Telephone Number	:	213-259-0606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2018
Last Update Date	:	08/09/2018

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