Provider Demographics
NPI:1023182599
Name:FLORES-MERRITT, ISABELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ISABELLA
Middle Name:
Last Name:FLORES-MERRITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 TACOMA NARROWS ST
Mailing Address - Street 2:
Mailing Address - City:W SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-5811
Mailing Address - Country:US
Mailing Address - Phone:916-372-5555
Mailing Address - Fax:916-483-4748
Practice Address - Street 1:6501 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0306
Practice Address - Country:US
Practice Address - Phone:916-423-3255
Practice Address - Fax:916-483-4748
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84790208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA71-0989922OtherTAX ID
CA00A84790Medicaid
CA71-0989922OtherTAX ID
CAI22433Medicare UPIN