Healthcare Provider Details

I. General information

NPI: 1700879228
Provider Name (Legal Business Name): SALVADOR MERCADO MERCADO SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 09/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SANTA ROSA AVE. AGUAS BUENAS BLQ. 16 OFICINA 34
SAN JUAN PR
00921
US

IV. Provider business mailing address

PO BOX 127
BAYAMON PR
00960-0127
US

V. Phone/Fax

Practice location:
  • Phone: 787-614-1929
  • Fax: 787-614-1929
Mailing address:
  • Phone: 787-614-1929
  • Fax: 787-614-1929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number5839
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: