Provider Demographics
NPI:1467810309
Name:DAVID, MARICAR MERCADO
Entity Type:Individual
Prefix:MRS
First Name:MARICAR
Middle Name:MERCADO
Last Name:DAVID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 MABURY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-4465
Mailing Address - Country:US
Mailing Address - Phone:714-595-9893
Mailing Address - Fax:
Practice Address - Street 1:1106 MABURY ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4465
Practice Address - Country:US
Practice Address - Phone:714-595-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-07
Last Update Date:2016-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA614964163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse