MEDICARE: MRS. JILLIAN MARIE MERCADO

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
1	3747P1801X	Personal Care Attendant		CA

General Provider Information

NPI Number	:	1790642973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILLIAN MARIE MERCADO

Provider Business Mailing Address
First Line	:	1531 E CHERRY HILL ST
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-6319
Country	:	US
Telephone Number	:	951-529-3917
Fax Number	:

Provider Business Practice Location Address
First Line	:	2416 S GROVE AVE STE 21
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-6224
Country	:	US
Telephone Number	:	951-529-3917
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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