Provider Demographics
NPI:1477587673
Name:DE LAS ALAS, MERCEDES ANN T (MD)
Entity Type:Individual
Prefix:
First Name:MERCEDES ANN
Middle Name:T
Last Name:DE LAS ALAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39765 DATE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2005
Mailing Address - Country:US
Mailing Address - Phone:951-894-4665
Mailing Address - Fax:951-894-5178
Practice Address - Street 1:39765 DATE ST STE 102
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2005
Practice Address - Country:US
Practice Address - Phone:951-894-4665
Practice Address - Fax:951-894-5178
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32495900Medicaid
G16690Medicare UPIN
WI0008Medicare ID - Type Unspecified