Healthcare Provider Details

I. General information

NPI: 1245779883
Provider Name (Legal Business Name): MISS KAMILLE SERRANZANA MERCADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E JULIAN ST
SAN JOSE CA
95112-4007
US

IV. Provider business mailing address

4289 CALLAN BLVD
DALY CITY CA
94015-4433
US

V. Phone/Fax

Practice location:
  • Phone: 408-918-2600
  • Fax:
Mailing address:
  • Phone: 650-303-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: