Healthcare Provider Details

I. General information

NPI: 1336063536
Provider Name (Legal Business Name): SOLEIL MICHELLE MERCADO GONZALEZ P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 1 BOX 6243A
LAS PIEDRAS PR
00771-9720
US

IV. Provider business mailing address

HC 1 BOX 6243A
LAS PIEDRAS PR
00771-9720
US

V. Phone/Fax

Practice location:
  • Phone: 787-661-4374
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3186-P.A.
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: