Healthcare Provider Details

I. General information

NPI: 1871308833
Provider Name (Legal Business Name): JORDAN MAGTOTO MERCADO FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N LINCOLN AVE STE 100
CORONA CA
92882-1853
US

IV. Provider business mailing address

110 N LINCOLN AVE STE 100
CORONA CA
92882-1853
US

V. Phone/Fax

Practice location:
  • Phone: 833-867-8462
  • Fax:
Mailing address:
  • Phone: 951-396-7341
  • Fax: 951-240-3581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95033828
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: