Healthcare Provider Details

I. General information

NPI: 1811081664
Provider Name (Legal Business Name): AUREA MERCADO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE C BB13 BAYAMON GARDENS
BAYAMON PR
00957
US

IV. Provider business mailing address

CALLE C BB13 BAYAMON GARDENS
BAYAMON PR
00957
US

V. Phone/Fax

Practice location:
  • Phone: 787-799-6297
  • Fax:
Mailing address:
  • Phone: 787-799-6297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14009
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: