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NPI Code Detail

MEDICARE: DR. JAMES GAVIN WALLACE-MERCADO DNP, MSN, FNP-C

MEDICARE: DR. JAMES GAVIN WALLACE-MERCADO DNP, MSN, FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner76798NM
2363LF0000XFamily Nurse Practitioner0024185745VA
3363LF0000XFamily Nurse Practitioner908120MS
4363LF0000XFamily Nurse Practitioner3-002726AL
5363LF0000XFamily Nurse PractitionerNP200003078DC
6363LF0000XFamily Nurse PractitionerAPRN11033095FL
7363LF0000XFamily Nurse PractitionerGAA-NP004634GA
8363LF0000XFamily Nurse PractitionerAC008761MD
9363LF0000XFamily Nurse Practitioner358275NY
10363LF0000XFamily Nurse Practitioner1168661TX

General Provider Information

NPI Number : 1023744406
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES GAVIN WALLACE-MERCADO DNP, MSN, FNP-C
Provider Business Mailing Address
First Line : 1 EMBARCADERO CTR STE 1900
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94111-3723
Country : US
Telephone Number : 888-663-6331
Fax Number :
Provider Business Practice Location Address
First Line : 1350 CONNECTICUT AVE NW STE 1250
Second Line :
City : WASHINGTON
State : DC
Zip : 20036-1728
Country : US
Telephone Number : 888-663-6331
Fax Number : 415-252-7176
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2022
Last Update Date : 05/25/2026

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