MEDICARE: RONALD MERRITT CPO

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	1744P3200X	Prosthetics Case Management

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0386410001	OTHER	CA	PTAN

General Provider Information

NPI Number	:	1497414882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD MERRITT CPO

Provider Business Mailing Address
First Line	:	2933 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1517
Country	:	US
Telephone Number	:	562-988-2414
Fax Number	:

Provider Business Practice Location Address
First Line	:	2933 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1517
Country	:	US
Telephone Number	:	562-988-2414
Fax Number	:

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

Provider Enumeration Date	:	12/13/2021
Last Update Date	:	12/13/2021

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