Provider Demographics
NPI:1326024126
Name:SANTIAGO MERCADO, VIRGINIA MARGARITA (BSMT)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:MARGARITA
Last Name:SANTIAGO MERCADO
Suffix:
Gender:F
Credentials:BSMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 DOMENECH AVE.
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-765-2556
Mailing Address - Fax:787-758-0308
Practice Address - Street 1:369 AVE DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3708
Practice Address - Country:US
Practice Address - Phone:787-765-2556
Practice Address - Fax:787-758-0308
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR315247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030978Medicare PIN