Healthcare Provider Details

I. General information

NPI: 1700837689
Provider Name (Legal Business Name): ALEJANDRO MERCADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
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:
Mailing address:
  • Phone: 916-550-2488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA56343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: