Provider Demographics
NPI:1205105418
Name:MERZA, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MERZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80175 AVENUE 52
Mailing Address - Street 2:#1713
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-7941
Mailing Address - Country:US
Mailing Address - Phone:408-506-1838
Mailing Address - Fax:
Practice Address - Street 1:400 S EL CIELO RD
Practice Address - Street 2:SUITE E/F
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7926
Practice Address - Country:US
Practice Address - Phone:760-416-1753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator