Provider Demographics
NPI:1679720965
Name:MERCADO, PATRICIA (DDS)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MERCADO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 GLORIOSA AVE
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-7823
Mailing Address - Country:US
Mailing Address - Phone:951-965-7955
Mailing Address - Fax:
Practice Address - Street 1:555 GLORIOSA AVE
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-7823
Practice Address - Country:US
Practice Address - Phone:951-965-7955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist