Provider Demographics
NPI:1922032598
Name:MERCADO, ROSA MARIA (MD)
Entity Type:Individual
Prefix:MS
First Name:ROSA
Middle Name:MARIA
Last Name:MERCADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13225 N FOUNTAIN HILLS BLVD
Mailing Address - Street 2:#254
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-3811
Mailing Address - Country:US
Mailing Address - Phone:480-816-1179
Mailing Address - Fax:
Practice Address - Street 1:13225 N FOUNTAIN HILLS BLVD
Practice Address - Street 2:#254
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3811
Practice Address - Country:US
Practice Address - Phone:480-816-1179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine