Provider Demographics
NPI:1821289166
Name:DR.MERLE YANEZA
Entity Type:Organization
Organization Name:DR.MERLE YANEZA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MERLE
Authorized Official - Middle Name:
Authorized Official - Last Name:YANEZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-830-7000
Mailing Address - Street 1:9146 SEPULVEDA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-6948
Mailing Address - Country:US
Mailing Address - Phone:818-830-7000
Mailing Address - Fax:818-830-7013
Practice Address - Street 1:9146 SEPULVEDA BLVD STE A
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-6948
Practice Address - Country:US
Practice Address - Phone:818-830-7000
Practice Address - Fax:818-830-7013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD27219122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B2721901OtherDENTICAL