Basic Information
| Provider Information | |||||||||
| NPI: | 1124272000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERCADO | ||||||||
| FirstName: | MA CRISTINA | ||||||||
| MiddleName: | MARIANO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MARIANO | ||||||||
| OtherFirstName: | MA CRISTINA | ||||||||
| OtherMiddleName: | TOMAS | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 123 TOMAHAWK CT | ||||||||
| Address2: | |||||||||
| City: | BELLE MEAD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085024105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9083597762 | ||||||||
| FaxNumber: | 9088379590 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 E ROMIE LN STE K | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939014031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314229066 | ||||||||
| FaxNumber: | 8314224312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2008 | ||||||||
| LastUpdateDate: | 03/04/2009 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 25MA08327500 | NJ | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 251118 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | A106427 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.