Provider Demographics
NPI:1760455174
Name:MERRITT, ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:MERRITT
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 1:23422 MILL CREEK DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1688
Mailing Address - Country:US
Mailing Address - Phone:949-900-1300
Mailing Address - Fax:949-900-1318
Practice Address - Street 1:23422 MILL CREEK DR
Practice Address - Street 2:SUITE 220
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1688
Practice Address - Country:US
Practice Address - Phone:949-900-1300
Practice Address - Fax:949-900-1318
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65482208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH20339Medicare UPIN
CAWA65482CMedicare ID - Type Unspecified