Provider Demographics
NPI:1295297778
Name:MERCADO, BRYANT (DPM)
Entity type:Individual
Prefix:DR
First Name:BRYANT
Middle Name:
Last Name:MERCADO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17654 HUMMINGBIRD WAY
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3262
Mailing Address - Country:US
Mailing Address - Phone:909-569-7052
Mailing Address - Fax:
Practice Address - Street 1:400 NEWPORT CENTER DR STE 706
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7661
Practice Address - Country:US
Practice Address - Phone:949-706-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5868213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty