Healthcare Provider Details

I. General information

NPI: 1316930431
Provider Name (Legal Business Name): AWILDA M MALDONADO-MERCADO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA
SAN JUAN PR
00921-3200
US

IV. Provider business mailing address

10 CALLE CASIA
SAN JUAN PR
00921-3200
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax: 787-641-4568
Mailing address:
  • Phone: 787-641-7582
  • Fax: 787-641-4568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number7692
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: