Provider Demographics
NPI:1104135433
Name:MERCADO SEPULVEDA, RAQUEL M (MD)
Entity type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:M
Last Name:MERCADO SEPULVEDA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1500 N WILMOT RD STE C260
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4416
Mailing Address - Country:US
Mailing Address - Phone:520-347-5662
Mailing Address - Fax:520-347-5895
Practice Address - Street 1:1500 N WILMOT RD STE C260
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4416
Practice Address - Country:US
Practice Address - Phone:520-347-5662
Practice Address - Fax:520-347-5895
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2019-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ46371207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ702139Medicaid