Healthcare Provider Details

I. General information

NPI: 1396368627
Provider Name (Legal Business Name): KRISTINA CORRINE MERINO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 SILVER CREEK RD
BULLHEAD CITY AZ
86442-7924
US

IV. Provider business mailing address

2735 SILVER CREEK RD
BULLHEAD CITY AZ
86442-7924
US

V. Phone/Fax

Practice location:
  • Phone: 928-763-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number012510
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: