Provider Demographics
NPI:1578853511
Name:MERCADO, JAKE RAYMUND RAMIREZ (PT)
Entity Type:Individual
Prefix:MR
First Name:JAKE RAYMUND
Middle Name:RAMIREZ
Last Name:MERCADO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4076 ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-8571
Mailing Address - Country:US
Mailing Address - Phone:818-614-4904
Mailing Address - Fax:
Practice Address - Street 1:4076 ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-8571
Practice Address - Country:US
Practice Address - Phone:818-614-4904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37301225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist