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NPI Code Detail

MEDICARE: JUDE MERAZ SUD/CHW

MEDICARE: JUDE MERAZ SUD/CHW
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
1101YA0400XAddiction (Substance Use Disorder) Counselor21929CA
2172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1558099978
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDE MERAZ SUD/CHW
Provider Business Mailing Address
First Line : 5320 S BROADWAY
Second Line :
City : LOS ANGELES
State : CA
Zip : 90037-3808
Country : US
Telephone Number : 323-325-7510
Fax Number :
Provider Business Practice Location Address
First Line : 7344 MAGNOLIA AVE STE 110
Second Line :
City : RIVERSIDE
State : CA
Zip : 92504-3819
Country : US
Telephone Number : 951-404-0856
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2022
Last Update Date : 12/16/2024

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Directions to “ JUDE MERAZ SUD/CHW” Practice Location

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