Basic Information
| Provider Information | |||||||||
| NPI: | 1255094223 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERCADO | ||||||||
| FirstName: | KATELYN | ||||||||
| MiddleName: | ROSEMARY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5402 HOLLY RD STE 2102 | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784114673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3614000277 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2230 SARATOGA BLVD | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784173400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618814788 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2021 | ||||||||
| LastUpdateDate: | 10/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | TX | N | 193400000X SINGLE SPECIALTY GROUP | 106S00000X | Y |
No ID Information.