Healthcare Provider Details

I. General information

NPI: 1922627272
Provider Name (Legal Business Name): JENNIFER MERCADO MUNIZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MERCADO MUNIZ MD

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 W LINCOLN AVE
YAKIMA WA
98902-2473
US

IV. Provider business mailing address

501 S 5TH AVE
YAKIMA WA
98902-3550
US

V. Phone/Fax

Practice location:
  • Phone: 509-452-4520
  • Fax: 509-452-5224
Mailing address:
  • Phone: 509-853-1082
  • Fax: 509-573-6275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberML61685672
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61570569
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD61570569
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: