Healthcare Provider Details

I. General information

NPI: 1245164581
Provider Name (Legal Business Name): JESENIA OTERO MERCADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 CALLE TIGRIS
BARCELONETA PR
00617-9447
US

IV. Provider business mailing address

94 CALLE TIGRIS
BARCELONETA PR
00617-9447
US

V. Phone/Fax

Practice location:
  • Phone: 939-261-1260
  • Fax:
Mailing address:
  • Phone: 939-261-1260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number98502
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: