Healthcare Provider Details

I. General information

NPI: 1124272000
Provider Name (Legal Business Name): MA CRISTINA MARIANO MERCADO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MA CRISTINA TOMAS MARIANO M.D.

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E ROMIE LN STE K
SALINAS CA
93901-4031
US

IV. Provider business mailing address

123 TOMAHAWK CT
BELLE MEAD NJ
08502-4105
US

V. Phone/Fax

Practice location:
  • Phone: 831-422-9066
  • Fax: 831-422-4312
Mailing address:
  • Phone: 908-359-7762
  • Fax: 908-837-9590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08327500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number251118
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA106427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: