Healthcare Provider Details

I. General information

NPI: 1144515792
Provider Name (Legal Business Name): FAITH CHERYLE ABALOS MERINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FAITH CHERYLE ABALOS-MERINO MD

II. Dates (important events)

Enumeration Date: 06/11/2011
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PINOLE VALLEY RD
PINOLE CA
94564-1384
US

IV. Provider business mailing address

15 BONNY DOONE
HERCULES CA
94547-3947
US

V. Phone/Fax

Practice location:
  • Phone: 510-243-4100
  • Fax:
Mailing address:
  • Phone: 714-875-9367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME110135
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC138791
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: