MEDICARE: MS. JACQUELINE M MERAZ

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851898423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELINE M MERAZ

Provider Business Mailing Address
First Line	:	4020 N VALLEY DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-6844
Country	:	US
Telephone Number	:	575-571-2724
Fax Number	:	575-571-2724

Provider Business Practice Location Address
First Line	:	4020 N VALLEY DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-6844
Country	:	US
Telephone Number	:	575-571-2724
Fax Number	:	575-571-2724

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

Provider Enumeration Date	:	04/10/2018
Last Update Date	:	04/10/2018

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