Provider Demographics
NPI:1902582430
Name:MERCADO, ERICA (PA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:MERCADO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 BLACK WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-9593
Mailing Address - Country:US
Mailing Address - Phone:209-585-6563
Mailing Address - Fax:
Practice Address - Street 1:2521 BLACK WALNUT DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-9593
Practice Address - Country:US
Practice Address - Phone:209-585-6563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant