Provider Demographics
NPI:1457673030
Name:MERCADO, AVELIZA (LAC)
Entity Type:Individual
Prefix:
First Name:AVELIZA
Middle Name:
Last Name:MERCADO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:320 E MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37408-1609
Mailing Address - Country:US
Mailing Address - Phone:423-643-2246
Mailing Address - Fax:423-643-2030
Practice Address - Street 1:1100 E 3RD ST
Practice Address - Street 2:SUITE G-100
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2241
Practice Address - Country:US
Practice Address - Phone:423-643-2246
Practice Address - Fax:423-643-2030
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNACU112171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist