Provider Demographics
NPI:1487068318
Name:MERRIN, LEAH VICTORIA (PA-C)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:VICTORIA
Last Name:MERRIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 S EL CAMINO REAL
Mailing Address - Street 2:STE. 100
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6208
Mailing Address - Country:US
Mailing Address - Phone:760-681-5222
Mailing Address - Fax:
Practice Address - Street 1:2122 S EL CAMINO REAL
Practice Address - Street 2:STE. 100
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6208
Practice Address - Country:US
Practice Address - Phone:760-681-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical