1508269598 NPI number — MARILOU MERCADO-ULIT,D.D.S. INC.

Table of content: (NPI 1508269598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508269598 NPI number — MARILOU MERCADO-ULIT,D.D.S. INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARILOU MERCADO-ULIT,D.D.S. INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508269598
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2105 BEVERLY BLVD STE 125
Provider Second Line Business Mailing Address:
SUITE# 125
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90057-2260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-413-8766
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2105 BEVERLY BLVD STE 125
Provider Second Line Business Practice Location Address:
SUITE# 125
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-2260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-413-8766
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ULIT
Authorized Official First Name:
MARILOU
Authorized Official Middle Name:
MERCADO-
Authorized Official Title or Position:
DENTIST/OWNER
Authorized Official Telephone Number:
213-413-8766

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G90642-01 . This is a "DELTA DENTAL/MEDICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1972679603 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1972679603 . This is a "DENTI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1972679603 . This is a "MEDICAL/DENTICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1972679603 . This is a "DENTICAL/MEDICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 122300000X , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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