Provider Demographics
NPI:1891405593
Name:MERCIER, FANJA
Entity Type:Individual
Prefix:
First Name:FANJA
Middle Name:
Last Name:MERCIER
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 1:18845 OLD MONTEREY RD
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-3094
Mailing Address - Country:US
Mailing Address - Phone:303-834-2419
Mailing Address - Fax:
Practice Address - Street 1:171 W EDMUNDSON AVE
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-5334
Practice Address - Country:US
Practice Address - Phone:303-834-2419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator