Provider Demographics
NPI:1073628657
Name:MERIS, MARIA CORAZON A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA CORAZON
Middle Name:A
Last Name:MERIS
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 1:3400 W BALL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3738
Mailing Address - Country:US
Mailing Address - Phone:714-816-0088
Mailing Address - Fax:714-816-0005
Practice Address - Street 1:3400 W BALL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3738
Practice Address - Country:US
Practice Address - Phone:714-816-0088
Practice Address - Fax:714-816-0005
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56490174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA56490OtherMEDICAL LICENSE NUMBER
CA00A564900Medicaid
CA00A564900Medicaid
CAG73965Medicare UPIN
CA00A564900Medicaid