Healthcare Provider Details

I. General information

NPI: 1225975238
Provider Name (Legal Business Name): MERRISSA FALLER WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11818 WILSHIRE BLVD STE 300
LOS ANGELES CA
90025-6648
US

IV. Provider business mailing address

1664 YORKTOWN LN
SAN PEDRO CA
90732-6108
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-4008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95039348
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: