Provider Demographics
NPI:1376181479
Name:MERAKI WELLNESS GROUP, LLC
Entity Type:Organization
Organization Name:MERAKI WELLNESS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:TONO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-651-7607
Mailing Address - Street 1:PO BOX 54695
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73154-1695
Mailing Address - Country:US
Mailing Address - Phone:405-651-7607
Mailing Address - Fax:405-942-3873
Practice Address - Street 1:1211 N SHARTEL AVE STE 802
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2425
Practice Address - Country:US
Practice Address - Phone:405-651-7607
Practice Address - Fax:405-942-3873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty