Healthcare Provider Details

I. General information

NPI: 1093836108
Provider Name (Legal Business Name): CARMEN TERESA MERCADO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2279 PONCE BY PASS CARIBEAN MEDICAL CENTRE SUITE 2312-2
PONCE PR
00717
US

IV. Provider business mailing address

CARIBBEAN MEDICAL CENTRE SUITE 2312-3
PONCE PR
00717
US

V. Phone/Fax

Practice location:
  • Phone: 787-231-7697
  • Fax:
Mailing address:
  • Phone: 787-231-7697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8857
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: