Provider Demographics
NPI:1285314179
Name:MERCADO, NERIZA GOMEZ (MD)
Entity type:Individual
Prefix:
First Name:NERIZA
Middle Name:GOMEZ
Last Name:MERCADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NERIZA
Other - Middle Name:SANTOS
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12408 SE 259TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-8438
Mailing Address - Country:US
Mailing Address - Phone:253-802-2709
Mailing Address - Fax:
Practice Address - Street 1:1031 SW 130TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98146-3132
Practice Address - Country:US
Practice Address - Phone:206-242-3213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML61462622207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine