Provider Demographics
NPI:1164432035
Name:MULDER, MERCY ROSE I (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MERCY
Middle Name:ROSE
Last Name:MULDER
Suffix:I
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13768 ROSWELL AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1405
Mailing Address - Country:US
Mailing Address - Phone:909-628-4205
Mailing Address - Fax:909-628-4875
Practice Address - Street 1:13768 ROSWELL AVE STE 202
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1405
Practice Address - Country:US
Practice Address - Phone:909-628-4205
Practice Address - Fax:909-628-4875
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 17661363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant