Provider Demographics
NPI:1033411426
Name:MERCADO, JUAN MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:MANUEL
Last Name:MERCADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 VIA DEL MONTE
Mailing Address - Street 2:PARQUE DEL MONTE
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6089
Mailing Address - Country:US
Mailing Address - Phone:787-236-3918
Mailing Address - Fax:
Practice Address - Street 1:61 VIA DEL MONTE
Practice Address - Street 2:PARQUE DEL MONTE
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-6089
Practice Address - Country:US
Practice Address - Phone:787-236-3918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18097208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice