MEDICARE: NIVIANA ADELMARY YAMBO-MERCADO O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	599	PR

General Provider Information

NPI Number	:	1477616258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIVIANA ADELMARY YAMBO-MERCADO O.D.

Provider Business Mailing Address
First Line	:	MANSION REAL
Second Line	:	223 ISABEL ST.
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-2601
Country	:	US
Telephone Number	:	787-840-4646
Fax Number	:	787-840-4646

Provider Business Practice Location Address
First Line	:	1718 CARR 506
Second Line	:	SUITE 101
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-2601
Country	:	US
Telephone Number	:	787-840-4646
Fax Number	:	787-840-4646

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	10/28/2021

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