Healthcare Provider Details

I. General information

NPI: 1093273203
Provider Name (Legal Business Name): MARINA MERCADO RAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 SUN ST
SALINAS CA
93901-3761
US

IV. Provider business mailing address

29 SUN ST
SALINAS CA
93901-3761
US

V. Phone/Fax

Practice location:
  • Phone: 831-883-3030
  • Fax:
Mailing address:
  • Phone: 831-883-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1337030219
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: