Provider Demographics
NPI:1316392756
Name:MERVIN, ADDIAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ADDIAS
Middle Name:
Last Name:MERVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 34TH ST STE 100&200
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2305
Mailing Address - Country:US
Mailing Address - Phone:833-678-2781
Mailing Address - Fax:
Practice Address - Street 1:625 34TH ST STE 100&200
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2305
Practice Address - Country:US
Practice Address - Phone:833-678-2781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT67250207V00000X
390200000X
CAA183295207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program