Healthcare Provider Details

I. General information

NPI: 1093925596
Provider Name (Legal Business Name): MARIANA MERCADO TS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO DE SALUD CONDUCTUAL DE MAYAGUEZ HOSP. RAMON EMETERIO BETANCES
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

P O BOX 7004
PONCE PR
00732-7004
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-2575
  • Fax: 787-840-8391
Mailing address:
  • Phone: 787-840-2575
  • Fax: 787-840-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5740
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: