Individual
NICOLE MAE SAN MATEO MERCADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2500 BELLE CHASSE HWY, TERRYTOWN, LA 70056-7127
(504) 392-3131
Mailing address
2500 BELLE CHASSE HWY, TERRYTOWN, LA 70056-7127
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
303576
LA
Other
Enumeration date
09/06/2016
Last updated
09/06/2016
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