Provider Demographics
NPI:1942038658
Name:MERCADO, NEIL JETRHO SOBREVINAS (BSN, RN)
Entity type:Individual
Prefix:MR
First Name:NEIL JETRHO
Middle Name:SOBREVINAS
Last Name:MERCADO
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 ONEONTA KNL
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4611
Mailing Address - Country:US
Mailing Address - Phone:650-863-4586
Mailing Address - Fax:
Practice Address - Street 1:1417 ONEONTA KNL
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4611
Practice Address - Country:US
Practice Address - Phone:650-863-4586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95136514163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse