Provider Demographics
NPI:1164509923
Name:SANTANA, ALFRED MERCADO I
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:MERCADO
Last Name:SANTANA
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 AVE UNIVERSIDAD INTERAMERICANA
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683
Mailing Address - Country:US
Mailing Address - Phone:787-892-1599
Mailing Address - Fax:787-892-1599
Practice Address - Street 1:104 AVE UNIVERSIDAD INTERAMERICANA
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-1599
Practice Address - Fax:787-892-1599
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0257350001Medicare NSC