Provider Demographics
NPI:1811107923
Name:MERINO, MITRA RAKI (PTA)
Entity type:Individual
Prefix:MRS
First Name:MITRA
Middle Name:RAKI
Last Name:MERINO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2676 VILLAS WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-6728
Mailing Address - Country:US
Mailing Address - Phone:925-200-9765
Mailing Address - Fax:
Practice Address - Street 1:2676 VILLAS WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-6728
Practice Address - Country:US
Practice Address - Phone:925-200-9765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant