Provider Demographics
NPI:1770686354
Name:MERCENE, OVID PRINCIPE (MD)
Entity Type:Individual
Prefix:DR
First Name:OVID
Middle Name:PRINCIPE
Last Name:MERCENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 BEVERLY BLVD
Mailing Address - Street 2:STE 233
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2216
Mailing Address - Country:US
Mailing Address - Phone:213-413-9695
Mailing Address - Fax:213-413-1841
Practice Address - Street 1:2105 BEVERLY BLVD
Practice Address - Street 2:STE 233
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2216
Practice Address - Country:US
Practice Address - Phone:213-413-9695
Practice Address - Fax:213-413-1841
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A422240Medicaid
CA00A422240Medicaid
CAOMA42224Medicare ID - Type Unspecified