Healthcare Provider Details

I. General information

NPI: 1972571396
Provider Name (Legal Business Name): MERCEDES LOPEZ TAVERAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROAD 149 KM 12.3
CIALES PR
00638
US

IV. Provider business mailing address

PO BOX 1427
CIALES PR
00638-1427
US

V. Phone/Fax

Practice location:
  • Phone: 787-871-0601
  • Fax: 787-871-3960
Mailing address:
  • Phone: 787-871-0601
  • Fax: 787-871-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5073
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: