Provider Demographics
NPI:1639598170
Name:MERCER, HOSEA
Entity Type:Individual
Prefix:
First Name:HOSEA
Middle Name:
Last Name:MERCER
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 1:22373 BLUE LUPINE CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5466
Mailing Address - Country:US
Mailing Address - Phone:661-546-2417
Mailing Address - Fax:
Practice Address - Street 1:22373 BLUE LUPINE CIR
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5466
Practice Address - Country:US
Practice Address - Phone:661-546-2417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA4647913172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver