MEDICARE: PAUL MERTENS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	373H00000X	Day Training/Habilitation Specialist
2	171M00000X	Case Manager/Care Coordinator
3	225C00000X	Rehabilitation Counselor

General Provider Information

NPI Number	:	1124794862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL MERTENS

Provider Business Mailing Address
First Line	:	PO BOX 1144
Second Line	:
City	:	SAN ANDREAS
State	:	CA
Zip	:	95249-1144
Country	:	US
Telephone Number	:	209-754-1249
Fax Number	:	209-754-1087

Provider Business Practice Location Address
First Line	:	3585 HAWVER RD.
Second Line	:
City	:	SAN ANDREAS
State	:	CA
Zip	:	95249
Country	:	US
Telephone Number	:	209-754-1249
Fax Number	:	209-754-1087

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	12/16/2025

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