Provider Demographics
NPI:1306304639
Name:NAZARENO, MERCEDES CRISTINA (NP)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:CRISTINA
Last Name:NAZARENO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15000 BURBANK BLVD APT 202
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-3665
Mailing Address - Country:US
Mailing Address - Phone:310-709-7079
Mailing Address - Fax:
Practice Address - Street 1:818 W CAMERON AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-4136
Practice Address - Country:US
Practice Address - Phone:626-337-6246
Practice Address - Fax:866-559-8301
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAG10180002251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health