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General NPI Number Information
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NPI Number | 1497119705
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Entity Type | Individual
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Provider Name | MARYA MERRITT D.C.
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Gender | Female
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Dates
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Enumeration Date | 04/12/2016
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Last Update Date | 04/12/2016
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Provider Practice Location Address
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Address Line | 4340 REDWOOD HWY C414
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2121
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Country | US
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Telephone | 415-472-2232
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Fax | 415-472-2212
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Provider Business Mailing Address
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Address Line | 4340 REDWOOD HWY C414
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2121
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Country | US
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Telephone | 415-472-2232
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Fax | 415-472-2212
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 14011
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License Number State | CA
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