Provider Demographics
NPI:1033894555
Name:MERCADO, CRISTIAN DANIEL (RD,MSM)
Entity Type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:DANIEL
Last Name:MERCADO
Suffix:
Gender:M
Credentials:RD,MSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4059 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3118
Mailing Address - Country:US
Mailing Address - Phone:626-277-7924
Mailing Address - Fax:
Practice Address - Street 1:4059 STEWART AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3118
Practice Address - Country:US
Practice Address - Phone:626-277-7924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86150290133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered