Healthcare Provider Details

I. General information

NPI: 1841700127
Provider Name (Legal Business Name): LLOYD MERINO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N MUNDO DR
DULCE NM
87528-5176
US

IV. Provider business mailing address

PO BOX 187
DULCE NM
87528-0187
US

V. Phone/Fax

Practice location:
  • Phone: 575-759-3291
  • Fax: 575-759-3532
Mailing address:
  • Phone: 575-759-3291
  • Fax: 575-759-3532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2017-0084
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: