Provider Demographics
NPI:1659301638
Name:AGUDO, MERCEDES E (MD, FAPA, DFAACAP)
Entity Type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:E
Last Name:AGUDO
Suffix:
Gender:F
Credentials:MD, FAPA, DFAACAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3842 E THUNDERBIRD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5770
Mailing Address - Country:US
Mailing Address - Phone:602-259-2000
Mailing Address - Fax:602-259-2009
Practice Address - Street 1:3842 E THUNDERBIRD RD STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5770
Practice Address - Country:US
Practice Address - Phone:602-599-2000
Practice Address - Fax:602-599-2009
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ371602084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019655190001Medicaid
AZ266126Medicaid
069554GHEMedicare ID - Type Unspecified