Healthcare Provider Details

I. General information

NPI: 1184587750
Provider Name (Legal Business Name): AZUCENA MERAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2762 HIGH CEDARS LN
MEDFORD OR
97504-3416
US

IV. Provider business mailing address

2762 HIGH CEDARS LN
MEDFORD OR
97504-3416
US

V. Phone/Fax

Practice location:
  • Phone: 458-226-6282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: