Provider Demographics
NPI:1891144374
Name:MERCADO, JOHN PAUL BACALTOS (NP)
Entity Type:Individual
Prefix:
First Name:JOHN PAUL
Middle Name:BACALTOS
Last Name:MERCADO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4415
Mailing Address - Country:US
Mailing Address - Phone:775-770-7600
Mailing Address - Fax:775-770-7880
Practice Address - Street 1:18653 WEDGE PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-3323
Practice Address - Country:US
Practice Address - Phone:775-770-7210
Practice Address - Fax:775-770-7211
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN62564163W00000X
NVAPRN002196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse