Healthcare Provider Details

I. General information

NPI: 1508756487
Provider Name (Legal Business Name): GLADYS GISELLE MERCADAL RBT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 N GARFIELD ST
MIDLAND TX
79705-6329
US

IV. Provider business mailing address

1110 CEDAR CREEK RD
MIDLAND TX
79705-4438
US

V. Phone/Fax

Practice location:
  • Phone: 575-309-1320
  • Fax:
Mailing address:
  • Phone: 575-309-1320
  • 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 StateTX
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-376644
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: