Provider Demographics
NPI:1255595351
Name:MERCADO, PAMELA ENRIQUEZ (DO)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:ENRIQUEZ
Last Name:MERCADO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6806 YARROW CT
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-4529
Mailing Address - Country:US
Mailing Address - Phone:714-292-6522
Mailing Address - Fax:
Practice Address - Street 1:6806 YARROW CT
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-4529
Practice Address - Country:US
Practice Address - Phone:714-292-6522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9981207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1881880615OtherPRIOR NPI NUMBER 1881880615