=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821289166
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR.MERLE YANEZA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2007
-----------------------------------------------------
Last Update Date | 08/01/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9146 SEPULVEDA BLVD STE A
-----------------------------------------------------
City | NORTH HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91343-6948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-830-7000
-----------------------------------------------------
Fax | 818-830-7013
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9146 SEPULVEDA BLVD STE A
-----------------------------------------------------
City | NORTH HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91343-6948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-830-7000
-----------------------------------------------------
Fax | 818-830-7013
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | MERLE YANEZA
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 818-830-7000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | D27219
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | D27219
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------