Provider Demographics
NPI:1518465012
Name:MERCADO, CESAR ALEJANDRO
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:ALEJANDRO
Last Name:MERCADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 SHARON DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:OR
Mailing Address - Zip Code:97535-5713
Mailing Address - Country:US
Mailing Address - Phone:541-499-9173
Mailing Address - Fax:
Practice Address - Street 1:137 SHARON DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:OR
Practice Address - Zip Code:97535-5713
Practice Address - Country:US
Practice Address - Phone:541-499-9173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist