Provider Demographics
NPI:1447560339
Name:LUGOD-MANALAD, MARY ANN MERCADO (NP-C)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:MERCADO
Last Name:LUGOD-MANALAD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MARY ANN
Other - Middle Name:LUGOD
Other - Last Name:MANALAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4934 BELLA COLLINA ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-1913
Mailing Address - Country:US
Mailing Address - Phone:760-295-6053
Mailing Address - Fax:
Practice Address - Street 1:310 SANTA FE DR
Practice Address - Street 2:STE 112
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5110
Practice Address - Country:US
Practice Address - Phone:760-632-9600
Practice Address - Fax:760-632-9669
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20249363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily