MEDICARE: MS. IMELDA ABALOS MERRERA R.N.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	597542	CA

General Provider Information

NPI Number	:	1457470239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IMELDA ABALOS MERRERA R.N.

Provider Business Mailing Address
First Line	:	2962 GAMMON CT
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-6536
Country	:	US
Telephone Number	:	707-315-8251
Fax Number	:

Provider Business Practice Location Address
First Line	:	2962 GAMMON CT
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-6536
Country	:	US
Telephone Number	:	707-315-8251
Fax Number	:

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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