Provider Demographics
NPI:1073345732
Name:MERCADO, SETH ANGEL
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:ANGEL
Last Name:MERCADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 N HUDSON AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-3649
Mailing Address - Country:US
Mailing Address - Phone:323-376-7129
Mailing Address - Fax:
Practice Address - Street 1:823 N HUDSON AVE APT 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-3649
Practice Address - Country:US
Practice Address - Phone:323-376-7129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker