Provider Demographics
NPI:1235148289
Name:MERAZ, RODRICK L (PA)
Entity Type:Individual
Prefix:
First Name:RODRICK
Middle Name:L
Last Name:MERAZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11919 HESPERIA RD
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-2158
Mailing Address - Country:US
Mailing Address - Phone:760-948-1454
Mailing Address - Fax:760-948-6100
Practice Address - Street 1:11919 HESPERIA RD
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-2158
Practice Address - Country:US
Practice Address - Phone:760-948-1454
Practice Address - Fax:760-948-6100
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12560146D00000X, 363AM0700X
AZ3589363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ410187Medicaid