Provider Demographics
NPI:1508909888
Name:MERCADO, STEPHANIE HARRIS (PA-C)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:HARRIS
Last Name:MERCADO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:2625 E DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1431
Mailing Address - Country:US
Mailing Address - Phone:559-443-2682
Mailing Address - Fax:559-443-2681
Practice Address - Street 1:785 N MEDICAL CENTER DR W STE 203
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6878
Practice Address - Country:US
Practice Address - Phone:559-387-1900
Practice Address - Fax:559-387-1950
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA19059363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical