Provider Demographics
NPI:1326001439
Name:EGBUJOR, MERCY (NP)
Entity Type:Individual
Prefix:
First Name:MERCY
Middle Name:
Last Name:EGBUJOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 S BASCOM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2604
Mailing Address - Country:US
Mailing Address - Phone:408-885-5000
Mailing Address - Fax:
Practice Address - Street 1:2011 LITTLE ORCHARD ST
Practice Address - Street 2:PUENTES CLINIC-INTERNAL MEDICINE
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-1031
Practice Address - Country:US
Practice Address - Phone:408-294-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA481610363L00000X, 363LA2200X, 363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP87501Medicare UPIN
CAZZZ26023ZMedicare PIN