Provider Demographics
NPI:1760984835
Name:MERCURO, JANELLE ANNE (RD)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:ANNE
Last Name:MERCURO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 W AVENIDA SAN GABRIEL
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-3263
Mailing Address - Country:US
Mailing Address - Phone:949-370-0829
Mailing Address - Fax:
Practice Address - Street 1:4 W AVENIDA SAN GABRIEL
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-3263
Practice Address - Country:US
Practice Address - Phone:949-370-0829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA818790133V00000X
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered