Healthcare Provider Details

I. General information

NPI: 1578664496
Provider Name (Legal Business Name): HIRAM MERCADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1785 CARR 21 LAS LOMAS
SAN JUAN PR
00921-3399
US

IV. Provider business mailing address

PO BOX 11981
SAN JUAN PR
00922-1981
US

V. Phone/Fax

Practice location:
  • Phone: 787-781-1450
  • Fax: 787-273-9177
Mailing address:
  • Phone: 787-781-1450
  • Fax: 787-273-9177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number2682
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: