Healthcare Provider Details

I. General information

NPI: 1891624276
Provider Name (Legal Business Name): MR. JACKLORD CARRASCO MERCADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 SW 20TH ST
MIRAMAR FL
33027-2517
US

IV. Provider business mailing address

8600 NW 198TH ST
HIALEAH FL
33015-6940
US

V. Phone/Fax

Practice location:
  • Phone: 954-682-7038
  • Fax:
Mailing address:
  • Phone: 305-333-1156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: