Healthcare Provider Details

I. General information

NPI: 1720995277
Provider Name (Legal Business Name): ALISON LARISSA DIAZ MERCADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E KEARSLEY ST
FLINT MI
48502-1907
US

IV. Provider business mailing address

303 E KEARSLEY ST
FLINT MI
48502-1907
US

V. Phone/Fax

Practice location:
  • Phone: 810-762-3172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085.012442
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: