Provider Demographics
NPI:1134082530
Name:MERCADEL, MARVELLA
Entity type:Individual
Prefix:
First Name:MARVELLA
Middle Name:
Last Name:MERCADEL
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 1:12021 S WILMINGTON AVE BLDG. 18
Mailing Address - Street 2:#5C
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-3019
Mailing Address - Country:US
Mailing Address - Phone:424-454-5490
Mailing Address - Fax:310-461-1132
Practice Address - Street 1:12021 S WILMINGTON AVE BLDG. 18
Practice Address - Street 2:#5C
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-3019
Practice Address - Country:US
Practice Address - Phone:424-454-5490
Practice Address - Fax:310-461-1132
Is Sole Proprietor?:No
Enumeration Date:2025-12-03
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist