Provider Demographics
NPI:1669804514
Name:MERCADO, JAY JORDAN YUMANG (RN)
Entity type:Individual
Prefix:MR
First Name:JAY JORDAN
Middle Name:YUMANG
Last Name:MERCADO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 CENTRAL BLVD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94542-1820
Mailing Address - Country:US
Mailing Address - Phone:510-815-3939
Mailing Address - Fax:
Practice Address - Street 1:1023 CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94542-1820
Practice Address - Country:US
Practice Address - Phone:510-815-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95173603163WH0200X, 163WH1000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice