Provider Demographics
NPI:1851920169
Name:MERCED, FELICITAS ENOVESO SHORTER
Entity Type:Individual
Prefix:
First Name:FELICITAS
Middle Name:ENOVESO SHORTER
Last Name:MERCED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16400 LIMERICK ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-5944
Mailing Address - Country:US
Mailing Address - Phone:805-264-9944
Mailing Address - Fax:805-264-9944
Practice Address - Street 1:16400 LIMERICK ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-5944
Practice Address - Country:US
Practice Address - Phone:805-264-9944
Practice Address - Fax:805-264-9944
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25661111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor