Healthcare Provider Details

I. General information

NPI: 1235439324
Provider Name (Legal Business Name): MERCADO MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2010
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 PROFESSIONAL DR
SACRAMENTO CA
95825-2162
US

IV. Provider business mailing address

1813 PROFESSIONAL DR
SACRAMENTO CA
95825-2162
US

V. Phone/Fax

Practice location:
  • Phone: 916-550-2488
  • Fax: 916-550-2925
Mailing address:
  • Phone: 916-550-2488
  • Fax: 916-550-2925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA 56343
License Number StateCA

VIII. Authorized Official

Name: DR. ALEJANDRO MERCADO
Title or Position: PRESIDENT / PHYSICIAN
Credential: M.D.
Phone: 916-550-2488