Provider Demographics
NPI:1073374146
Name:MERTENS, JUSTIN DEFENDIS
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:DEFENDIS
Last Name:MERTENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8840 N FULLER AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1626
Mailing Address - Country:US
Mailing Address - Phone:559-367-4171
Mailing Address - Fax:
Practice Address - Street 1:8840 N FULLER AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1626
Practice Address - Country:US
Practice Address - Phone:559-367-4171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA823734163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse