Provider Demographics
NPI:1972391787
Name:MERCADO HERNANDEZ, BLANCA M (PPS)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:M
Last Name:MERCADO HERNANDEZ
Suffix:
Gender:
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 5TH ST
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:CA
Mailing Address - Zip Code:93015-1055
Mailing Address - Country:US
Mailing Address - Phone:805-524-6781
Mailing Address - Fax:
Practice Address - Street 1:918 5TH ST
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:CA
Practice Address - Zip Code:93015-1055
Practice Address - Country:US
Practice Address - Phone:805-524-6781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200188289101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool