Provider Demographics
NPI:1922726843
Name:MERCADO-LEON, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MERCADO-LEON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5090 N PRIMITIVO WAY APT 125
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8235
Mailing Address - Country:US
Mailing Address - Phone:559-836-7601
Mailing Address - Fax:
Practice Address - Street 1:5090 N PRIMITIVO WAY APT 125
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8235
Practice Address - Country:US
Practice Address - Phone:559-836-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)