Provider Demographics
NPI:1932212131
Name:ZERMENO, GERMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GERMAN
Middle Name:
Last Name:ZERMENO
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 1:720 N TUSTIN AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3606
Mailing Address - Country:US
Mailing Address - Phone:714-565-1032
Mailing Address - Fax:714-565-1035
Practice Address - Street 1:720 N TUSTIN AVE STE 104
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3606
Practice Address - Country:US
Practice Address - Phone:714-565-1032
Practice Address - Fax:714-565-1035
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43064207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A430640Medicaid
CACW527ZOtherMEDICARE PTAN
CA00A430640OtherBLUE SHIELD
CA00A430640OtherBLUE SHIELD
CACW527ZOtherMEDICARE PTAN
CAE95714Medicare UPIN