Healthcare Provider Details

I. General information

NPI: 1376850024
Provider Name (Legal Business Name): DR SALVADOR MERCADO MERCADO CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIF. ROSSY CALLE BETANCES # 3
CIALES PR
00638
US

IV. Provider business mailing address

PO BOX 127
BAYAMON PR
00960-0127
US

V. Phone/Fax

Practice location:
  • Phone: 787-871-0446
  • Fax: 787-966-7577
Mailing address:
  • Phone: 787-966-7575
  • Fax: 787-966-7577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number5839
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number5839
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5839
License Number StatePR

VIII. Authorized Official

Name: DR. SALVADOR MERCADO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-966-7575