Healthcare Provider Details

I. General information

NPI: 1992844583
Provider Name (Legal Business Name): GEMMA MIRANDA MERCADO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GEMMA G. MIRANDA-MERCADO M.D.

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 YPAO RD
TAMUNING GU
96913-3701
US

IV. Provider business mailing address

NAVAL HOSPITAL GUAM PSC 490, BOX 9024
FPO AP
96538
US

V. Phone/Fax

Practice location:
  • Phone: 671-646-8881
  • Fax:
Mailing address:
  • Phone: 671-471-6025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA95009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: