Healthcare Provider Details

I. General information

NPI: 1073434502
Provider Name (Legal Business Name): HUASCAR CREALES MERCADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 AVE TITO CASTRO FL 4
PONCE PR
00716-4717
US

IV. Provider business mailing address

3640 CALLE CUMBRE URB. EL MONTE
PONCE PR
00716-4809
US

V. Phone/Fax

Practice location:
  • Phone: 787-848-2080
  • Fax:
Mailing address:
  • Phone: 787-379-0349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-1066
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: