Healthcare Provider Details

I. General information

NPI: 1508332305
Provider Name (Legal Business Name): LUIS MERCADO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 GEER RD STE B
TURLOCK CA
95382-1148
US

IV. Provider business mailing address

3650 GEER RD STE B
TURLOCK CA
95382-1148
US

V. Phone/Fax

Practice location:
  • Phone: 209-633-3014
  • Fax:
Mailing address:
  • Phone: 209-633-3014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberPA56630
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA56630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: