Healthcare Provider Details

I. General information

NPI: 1225035884
Provider Name (Legal Business Name): KAREN ELAINE MERCOLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 WILSHIRE BLVD STE 400
BEVERLY HILLS CA
90212-2103
US

IV. Provider business mailing address

9735 WILSHIRE BLVD STE 400
BEVERLY HILLS CA
90212-2103
US

V. Phone/Fax

Practice location:
  • Phone: 310-859-4948
  • Fax: 310-391-2660
Mailing address:
  • Phone: 310-859-4948
  • Fax: 310-391-2660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberG30394
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: