Healthcare Provider Details

I. General information

NPI: 1255259701
Provider Name (Legal Business Name): OLGA MERCADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 30TH ST STE A
SAN DIEGO CA
92154-3417
US

IV. Provider business mailing address

1424 30TH ST STE A
SAN DIEGO CA
92154-3417
US

V. Phone/Fax

Practice location:
  • Phone: 619-565-2650
  • Fax:
Mailing address:
  • Phone: 619-565-2650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: