MEDICARE: CRISTAL MERCEDES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1699462366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTAL MERCEDES

Provider Business Mailing Address
First Line	:	471 AUDUBON AVE APT 22
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10040-4626
Country	:	US
Telephone Number	:	917-756-5538
Fax Number	:

Provider Business Practice Location Address
First Line	:	471 AUDUBON AVE APT 22
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10040-4626
Country	:	US
Telephone Number	:	917-756-5538
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2023
Last Update Date	:	04/21/2023

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Directions to “ CRISTAL MERCEDES ” Practice Location

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