Provider Demographics
NPI:1265278535
Name:MARDONES HERNANDEZ, MERCEDES A
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:A
Last Name:MARDONES HERNANDEZ
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 1:3230 W LINCOLN AVE APT 230
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6017
Mailing Address - Country:US
Mailing Address - Phone:714-818-4826
Mailing Address - Fax:
Practice Address - Street 1:450 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4562
Practice Address - Country:US
Practice Address - Phone:714-542-7792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker