MEDICARE: DIANE MERRITT

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	754256	CA

General Provider Information

NPI Number	:	1568851541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE MERRITT

Provider Business Mailing Address
First Line	:	7438 BALLINGER AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-1317
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7438 BALLINGER AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-1317
Country	:	US
Telephone Number	:	619-461-8678
Fax Number	:

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

Provider Enumeration Date	:	01/14/2015
Last Update Date	:	01/14/2015

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Directions to “ DIANE MERRITT ” Practice Location

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