Provider Demographics
NPI:1528874252
Name:MERCADO, LYNETH ANDRES (OTR/L)
Entity type:Individual
Prefix:
First Name:LYNETH
Middle Name:ANDRES
Last Name:MERCADO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 TORTUGA CV
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-7996
Mailing Address - Country:US
Mailing Address - Phone:661-474-1845
Mailing Address - Fax:
Practice Address - Street 1:2201 MISSION AVE STE 200
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-2313
Practice Address - Country:US
Practice Address - Phone:760-826-7223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26998225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist