Provider Demographics
NPI:1235249467
Name:MERCADO DOMACASSE, DAISY MILAGROS (MEDICINE DOCTOR)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:MILAGROS
Last Name:MERCADO DOMACASSE
Suffix:
Gender:F
Credentials:MEDICINE DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 192993
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-2993
Mailing Address - Country:US
Mailing Address - Phone:787-667-4994
Mailing Address - Fax:
Practice Address - Street 1:2 AVE PERIFERAL APT 1402
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-2135
Practice Address - Country:US
Practice Address - Phone:787-667-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15465208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice