Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | CA |
NPI | 1033694070 |
---|---|
Provider Name | Wendy Lee Margaret Merritt |
First Address | La Habra, CA 90631-2533 |
Second Address | La Habra, CA 90631-2533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2018 |
Last Update Date | 04/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
369463069 | TRICARE (01) | |
3G18-JE7-UU45 | MEDICARE (01) |