Provider Demographics
NPI:1396195624
Name:MERCADO-GARCIA, FERNANDO ESAU (DDS)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:ESAU
Last Name:MERCADO-GARCIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25953 CAMPO CV
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-6531
Mailing Address - Country:US
Mailing Address - Phone:909-360-9076
Mailing Address - Fax:
Practice Address - Street 1:25953 CAMPO CV
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-6531
Practice Address - Country:US
Practice Address - Phone:909-360-9076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.030619122300000X
CA101290122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist