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General NPI Number Information
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NPI Number | 1679062913
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Entity Type | Individual
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Provider Name | JONATHAN CHARRIEZ MERCADO MD
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Gender | Male
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Dates
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Enumeration Date | 05/02/2018
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Last Update Date | 05/25/2023
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Provider Practice Location Address
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Address Line | 50 CALLE JOSE I QUINTON
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City | COAMO
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State | PR
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Zip | 00769-2408
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Country | US
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Telephone | 787-803-4774
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Fax |
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Provider Business Mailing Address
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Address Line | HC 72 BOX 3766-129
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City | NARANJITO
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State | PR
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Zip | 00719
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Country | US
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Telephone | 407-973-6799
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 21913
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License Number State | PR
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