Provider Demographics
NPI:1871308833
Name:MERCADO, JORDAN MAGTOTO (FNP-C)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MAGTOTO
Last Name:MERCADO
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7336 STOCKYARD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-0180
Mailing Address - Country:US
Mailing Address - Phone:951-259-8471
Mailing Address - Fax:
Practice Address - Street 1:14081 YORBA ST STE 106
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2050
Practice Address - Country:US
Practice Address - Phone:714-603-7451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine