Provider Demographics
NPI:1376836320
Name:MERRITT, TAMMY LAJAUN
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LAJAUN
Last Name:MERRITT
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 1:15095 AMARGOSA RD
Mailing Address - Street 2:201
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-1879
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15095 AMARGOSA RD
Practice Address - Street 2:101
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-1879
Practice Address - Country:US
Practice Address - Phone:760-245-4695
Practice Address - Fax:760-513-4696
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker