Provider Demographics
NPI:1316573843
Name:MERAZ NUNEZ, ROBERTO EMILIANO (PA)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:EMILIANO
Last Name:MERAZ NUNEZ
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 1:6642 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1312
Mailing Address - Country:US
Mailing Address - Phone:818-212-1418
Mailing Address - Fax:
Practice Address - Street 1:6642 FULTON AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1312
Practice Address - Country:US
Practice Address - Phone:818-212-1418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical