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General NPI Number Information
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NPI Number | 1174264402
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Entity Type | Individual
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Provider Name | CAROLINA MERCADO
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Gender | Female
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Dates
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Enumeration Date | 04/01/2022
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Last Update Date | 04/01/2022
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Provider Practice Location Address
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Address Line | 10200 NW 25TH ST # A-108
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City | DORAL
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State | FL
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Zip | 33172-5921
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Country | US
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Telephone | 786-717-5649
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Fax |
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Provider Business Mailing Address
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Address Line | 12823 SW 71ST LN
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City | MIAMI
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State | FL
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Zip | 33183-2442
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Country | US
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Telephone | 305-988-2415
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SI5294
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License Number State | FL
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