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General NPI Number Information
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NPI Number | 1598256208
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Entity Type | Individual
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Provider Name | ALEJANDRA YVON MERRIMAN DAT, MS, ATC, CES
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Gender | Female
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 05/29/2018
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Provider Practice Location Address
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Address Line | 3537 FARMDALE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90016-4707
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Country | US
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Telephone | 323-298-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 11205 BURIN AVE APT A
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City | INGLEWOOD
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State | CA
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Zip | 90304-2753
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Country | US
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Telephone |
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000010209
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License Number State | CA
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