Provider Demographics
NPI:1306810031
Name:DE LA MERCED, JOEL (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:DE LA MERCED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 CHINO AVENUE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1489
Mailing Address - Country:US
Mailing Address - Phone:909-902-9998
Mailing Address - Fax:909-902-0995
Practice Address - Street 1:3110 CHINO AVENUE
Practice Address - Street 2:SUITE 250
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1489
Practice Address - Country:US
Practice Address - Phone:909-902-9998
Practice Address - Fax:909-902-0995
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50414208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A504140Medicaid
CA20-5541380OtherEIN #