Healthcare Provider Details

I. General information

NPI: 1316792716
Provider Name (Legal Business Name): ALEXANDRA NICOLE MERCADO BAEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11785 NORTHFALL LN STE 508
ALPHARETTA GA
30009-7961
US

IV. Provider business mailing address

4825 CHASE LN
CUMMING GA
30040-0283
US

V. Phone/Fax

Practice location:
  • Phone: 787-691-5627
  • Fax:
Mailing address:
  • Phone: 787-691-5627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: