Provider Demographics
NPI:1386627263
Name:RAMOS-MERCADO, FABIOLA B (DMD)
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:B
Last Name:RAMOS-MERCADO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:FABIOLA
Other - Middle Name:B
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1500 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-5216
Mailing Address - Country:US
Mailing Address - Phone:916-443-3299
Mailing Address - Fax:916-325-1980
Practice Address - Street 1:1500 21ST ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811
Practice Address - Country:US
Practice Address - Phone:916-443-3299
Practice Address - Fax:916-325-1980
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031298L122300000X
NJ22DI02409500122300000X
CA102261122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012729750001Medicaid
NJ0207152Medicaid
090647F61OtherFEDERAL PROV. ID NO.
PAV04900Medicare ID - Type Unspecified