MEDICARE: JORGE HUMBERTO MERAZ

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1922415496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE HUMBERTO MERAZ

Provider Business Mailing Address
First Line	:	2851 N ARROWHEAD AVE
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92405-3407
Country	:	US
Telephone Number	:	909-831-2364
Fax Number	:

Provider Business Practice Location Address
First Line	:	2851 N ARROWHEAD AVE
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92405-3407
Country	:	US
Telephone Number	:	909-831-2364
Fax Number	:

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

Provider Enumeration Date	:	07/16/2014
Last Update Date	:	07/16/2014

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