Healthcare Provider Details

I. General information

NPI: 1780357814
Provider Name (Legal Business Name): VALERIE MERCADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 TECHNOLOGY CT
RIVERSIDE CA
92507-2191
US

IV. Provider business mailing address

525 TECHNOLOGY CT
RIVERSIDE CA
92507-2191
US

V. Phone/Fax

Practice location:
  • Phone: 951-686-8500
  • Fax:
Mailing address:
  • Phone: 951-686-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number118031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: