Provider Demographics
NPI:1689601973
Name:MERIC, JANEL LARSON (MD)
Entity Type:Individual
Prefix:MRS
First Name:JANEL
Middle Name:LARSON
Last Name:MERIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13422 NEWPORT AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:714-544-1521
Mailing Address - Fax:714-544-1904
Practice Address - Street 1:13422 NEWPORT AVE
Practice Address - Street 2:SUITE L
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-544-1521
Practice Address - Fax:714-544-1904
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC530372083P0500X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3125603OtherBLUE CROSS BLUE SHIELD
3125603OtherBLUE CROSS BLUE SHIELD
E99815Medicare UPIN