Healthcare Provider Details

I. General information

NPI: 1033583455
Provider Name (Legal Business Name): ENRIQUE MERELES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 EUCLID AVE
SAN DIEGO CA
92114
US

IV. Provider business mailing address

3021 W CANYON AVE
SAN DIEGO CA
92123-5421
US

V. Phone/Fax

Practice location:
  • Phone: 619-266-2111
  • Fax: 619-266-0496
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW82458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: