Individual
JOSE ANTONIO MERCADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3998 FAIR RIDGE DR, FAIRFAX, VA 22033-2907
(703) 295-9360
(703) 295-9369
Mailing address
PO BOX 37090, BALTIMORE, MD 21297-3090
(703) 295-9360
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0001199514
VA
Other
Enumeration date
01/19/2011
Last updated
12/24/2013
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