Provider Demographics
NPI:1013183854
Name:SEIDAKHMETOV, MERIZHAN MARATOVICH (DME SUPPLIER)
Entity Type:Individual
Prefix:
First Name:MERIZHAN
Middle Name:MARATOVICH
Last Name:SEIDAKHMETOV
Suffix:
Gender:M
Credentials:DME SUPPLIER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11220 LAUREL CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-4348
Mailing Address - Country:US
Mailing Address - Phone:818-837-0600
Mailing Address - Fax:818-837-0150
Practice Address - Street 1:11220 LAUREL CANYON BLVD. UNIT #F105 1/2
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91344-4348
Practice Address - Country:US
Practice Address - Phone:818-837-0600
Practice Address - Fax:818-837-0150
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator