Provider Demographics
NPI:1366805541
Name:MERCURIO, CARIZA (MD)
Entity type:Individual
Prefix:DR
First Name:CARIZA
Middle Name:
Last Name:MERCURIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12462 PUTNAM ST STE 303
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1049
Mailing Address - Country:US
Mailing Address - Phone:562-789-5440
Mailing Address - Fax:
Practice Address - Street 1:12462 PUTNAM ST STE 303
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1049
Practice Address - Country:US
Practice Address - Phone:562-789-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA154410207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1366805541Medicaid