Healthcare Provider Details

I. General information

NPI: 1508909888
Provider Name (Legal Business Name): STEPHANIE HARRIS MERCADO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 N MEDICAL CENTER DR W STE 203
CLOVIS CA
93611-6878
US

IV. Provider business mailing address

2625 E DIVISADERO ST
FRESNO CA
93721-1431
US

V. Phone/Fax

Practice location:
  • Phone: 559-387-1900
  • Fax: 559-387-1950
Mailing address:
  • Phone: 559-443-2682
  • Fax: 559-443-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA19059
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: