Healthcare Provider Details

I. General information

NPI: 1295167062
Provider Name (Legal Business Name): BIANCA VANESSA MERCADO LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 CAMINO DEL RIO S STE 206
SAN DIEGO CA
92108-4014
US

IV. Provider business mailing address

6752 HIBISCUS DR
LEMON GROVE CA
91945-1316
US

V. Phone/Fax

Practice location:
  • Phone: 408-209-2234
  • Fax: 619-761-5825
Mailing address:
  • Phone: 408-209-2234
  • Fax: 619-761-5825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM488
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number9863
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: