Healthcare Provider Details

I. General information

NPI: 1306810031
Provider Name (Legal Business Name): JOEL DE LA MERCED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 CHINO AVENUE SUITE 250
CHINO HILLS CA
91709-1489
US

IV. Provider business mailing address

3110 CHINO AVENUE SUITE 250
CHINO HILLS CA
91709-1489
US

V. Phone/Fax

Practice location:
  • Phone: 909-902-9998
  • Fax: 909-902-0995
Mailing address:
  • Phone: 909-902-9998
  • Fax: 909-902-0995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA50414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: