Provider Demographics
NPI:1851898423
Name:MERAZ, JACQUELINE M
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:M
Last Name:MERAZ
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 1:4020 N VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-6844
Mailing Address - Country:US
Mailing Address - Phone:575-571-2724
Mailing Address - Fax:575-571-2724
Practice Address - Street 1:4020 N VALLEY DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-6844
Practice Address - Country:US
Practice Address - Phone:575-571-2724
Practice Address - Fax:575-571-2724
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM45432333Medicaid