=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356326730
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANY SOLIS-MERCADO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE FRANCIA ESQ 1275
-----------------------------------------------------
City | AUTORREY SAN JAUN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-603-0016
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 52324
-----------------------------------------------------
City | TOA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00950-2324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-603-0016
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 14727
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------