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General NPI Number Information
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NPI Number | 1164432035
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Entity Type | Individual
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Provider Name | MERCY ROSE MULDER I PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 13768 ROSWELL AVE STE 202
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City | CHINO
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State | CA
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Zip | 91710-1405
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Country | US
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Telephone | 909-628-4205
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Fax | 909-628-4875
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Provider Business Mailing Address
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Address Line | 13768 ROSWELL AVE STE 202
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City | CHINO
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State | CA
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Zip | 91710-1405
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Country | US
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Telephone | 909-628-4205
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Fax | 909-628-4875
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 17661
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License Number State | CA
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