Healthcare Provider Details

I. General information

NPI: 1689599094
Provider Name (Legal Business Name): MERCEDES DE LOS SANTOS ELIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 MICHAEL CANLIS WAY
FRENCH CAMP CA
95231-9781
US

IV. Provider business mailing address

1840 N BAKER ST
STOCKTON CA
95204-5207
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-4400
  • Fax:
Mailing address:
  • Phone: 209-817-3289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number43249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: