Healthcare Provider Details

I. General information

NPI: 1053118034
Provider Name (Legal Business Name): KAILEY MERINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W LINCOLN AVE STE 130
ANAHEIM CA
92805-2993
US

IV. Provider business mailing address

303 W LINCOLN AVE STE 130
ANAHEIM CA
92805-2993
US

V. Phone/Fax

Practice location:
  • Phone: 714-520-7300
  • Fax:
Mailing address:
  • Phone: 714-520-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: