Provider Demographics
NPI:1447569868
Name:MERCADO, CHRISTINA CUARESMA (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:CUARESMA
Last Name:MERCADO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 MALAKOFF RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1553
Mailing Address - Country:US
Mailing Address - Phone:323-491-9702
Mailing Address - Fax:
Practice Address - Street 1:924 MALAKOFF RD
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1553
Practice Address - Country:US
Practice Address - Phone:323-491-9702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist