Healthcare Provider Details

I. General information

NPI: 1124726096
Provider Name (Legal Business Name): MS. BRUNILDA ANNETTE ALTIERI MERCADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 02/21/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MAYAGUEZ MEDICAL CENTER CARRETERA 2 KM157 SABALOS
MAYAGUEZ PR
00680-0068
US

IV. Provider business mailing address

22 CAMINO MORTERO
RINCON PR
00677-2649
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-0663
  • Fax:
Mailing address:
  • Phone: 939-339-9487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15863
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: