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General NPI Number Information
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NPI Number | 1871308833
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Entity Type | Individual
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Provider Name | JORDAN MAGTOTO MERCADO FNP-C
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Gender | Male
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 14081 YORBA ST STE 106
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City | TUSTIN
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State | CA
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Zip | 92780-2050
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Country | US
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Telephone | 714-603-7451
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Fax |
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Provider Business Mailing Address
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Address Line | 7336 STOCKYARD
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City | RIVERSIDE
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State | CA
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Zip | 92507-0180
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Country | US
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Telephone | 951-259-8471
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 95033828
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License Number State | CA
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