Provider Demographics
NPI:1205172806
Name:MERCER, VICKI LYNN ZLOTNICK
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN ZLOTNICK
Last Name:MERCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:ZLOTNICK
Other - Last Name:MERCER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:270 26TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-2566
Mailing Address - Country:US
Mailing Address - Phone:424-272-0686
Mailing Address - Fax:310-459-5809
Practice Address - Street 1:270 26TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90402-2566
Practice Address - Country:US
Practice Address - Phone:424-272-0686
Practice Address - Fax:310-459-5809
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 61820208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics