Healthcare Provider Details

I. General information

NPI: 1750092052
Provider Name (Legal Business Name): MAYALEN MERCADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 E 17TH ST
SANTA ANA CA
92701-2641
US

IV. Provider business mailing address

1206 E 17TH ST STE 101
SANTA ANA CA
92701-2641
US

V. Phone/Fax

Practice location:
  • Phone: 714-352-2911
  • Fax: 714-352-2903
Mailing address:
  • Phone: 760-975-2631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66627
License Number StateCA
# 2
Primary TaxonomyN
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: