Healthcare Provider Details

I. General information

NPI: 1659488773
Provider Name (Legal Business Name): BRENDA MERCADO MENDEZ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE.ROBERTO CLEMENTE BLOQUE129#27 VILLA CAROLINA
CAROLINA PR
00984
US

IV. Provider business mailing address

ST.126 BX6 VALLE ARRIBA HTS.
CAROLINA PR
00983
US

V. Phone/Fax

Practice location:
  • Phone: 787-752-0984
  • Fax: 787-752-0984
Mailing address:
  • Phone: 787-762-5538
  • Fax: 787-762-5538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11684
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number11684
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: