Provider Demographics
NPI:1295167062
Name:MERCADO, BIANCA VANESSA (LM, CPM)
Entity type:Individual
Prefix:MRS
First Name:BIANCA
Middle Name:VANESSA
Last Name:MERCADO
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6752 HIBISCUS DR
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1316
Mailing Address - Country:US
Mailing Address - Phone:408-209-2234
Mailing Address - Fax:619-761-5825
Practice Address - Street 1:3633 CAMINO DEL RIO S STE 206
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4014
Practice Address - Country:US
Practice Address - Phone:408-209-2234
Practice Address - Fax:619-761-5825
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM488176B00000X
CA9863374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula