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General NPI Number Information
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NPI Number | 1518674605
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Entity Type | Individual
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Provider Name | CATHLEEN VANESSA GUTIERREZ EXCONDE-MERCADO RN, NP
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Gender | Female
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 1620 E 2ND ST STE N
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City | BEAUMONT
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State | CA
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Zip | 92223-3172
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Country | US
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Telephone | 951-845-6500
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Fax | 866-856-0338
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Provider Business Mailing Address
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Address Line | 4798 S SCOTT WAY
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City | ONTARIO
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State | CA
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Zip | 91762-7365
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Country | US
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Telephone | 415-629-0525
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F10220152
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95023464
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License Number State | CA
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