Healthcare Provider Details

I. General information

NPI: 1922406982
Provider Name (Legal Business Name): MICAELA G MERCADO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2014
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 HUMBOLDT RD STE 200
CHICO CA
95928-9203
US

IV. Provider business mailing address

1469 HUMBOLDT RD STE 200
CHICO CA
95928-9203
US

V. Phone/Fax

Practice location:
  • Phone: 916-482-4856
  • Fax:
Mailing address:
  • Phone: 916-482-4856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number814583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: