Provider Demographics
NPI:1275938367
Name:HART, MERIBETH
Entity Type:Individual
Prefix:
First Name:MERIBETH
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W 5TH ST APT 212
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-7327
Mailing Address - Country:US
Mailing Address - Phone:424-259-8085
Mailing Address - Fax:424-259-8066
Practice Address - Street 1:2211 MICHIGAN AVENUE
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3905
Practice Address - Country:US
Practice Address - Phone:424-259-8085
Practice Address - Fax:424-259-8066
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21290363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily