Healthcare Provider Details

I. General information

NPI: 1255971743
Provider Name (Legal Business Name): MARIA THERESE DELA MERCED NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7012 RESEDA BLVD STE 100
RESEDA CA
91335-4219
US

IV. Provider business mailing address

10515 BALBOA BLVD STE 285
GRANADA HILLS CA
91344-6398
US

V. Phone/Fax

Practice location:
  • Phone: 747-265-6423
  • Fax:
Mailing address:
  • Phone: 661-310-8175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95013531
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95013531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: