Provider Demographics
NPI:1730375841
Name:RIVERA, MERCEDES YADAO (MD)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:YADAO
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 PORTER ST
Mailing Address - Street 2:APT G
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-7900
Mailing Address - Country:US
Mailing Address - Phone:562-481-9212
Mailing Address - Fax:
Practice Address - Street 1:1167 PORTER ST
Practice Address - Street 2:APT G
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590
Practice Address - Country:US
Practice Address - Phone:562-481-9212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109441207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine