Provider Demographics
NPI:1174628317
Name:MERINO, RICHARD ALFONSO (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALFONSO
Last Name:MERINO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:823 GATEWAY CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4541
Mailing Address - Country:US
Mailing Address - Phone:619-906-4623
Mailing Address - Fax:619-906-4564
Practice Address - Street 1:15721 POMERADO RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2021
Practice Address - Country:US
Practice Address - Phone:858-485-6644
Practice Address - Fax:858-485-0371
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2013-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG36036207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG36036Medicare ID - Type Unspecified
CAA89610Medicare UPIN