Provider Demographics
NPI:1477504520
Name:DE CHOUDENS, MERCEDES E (MD)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:E
Last Name:DE CHOUDENS
Suffix:
Gender:F
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:PHB 249
Mailing Address - Street 2:130 WINSTON CHURCHILL AVE STE 1
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6018
Mailing Address - Country:US
Mailing Address - Phone:787-764-9493
Mailing Address - Fax:787-759-3621
Practice Address - Street 1:1755 CALLE PARANA
Practice Address - Street 2:URB CROWN HILL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6049
Practice Address - Country:US
Practice Address - Phone:787-764-9493
Practice Address - Fax:787-759-3621
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR112822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0088045Medicare ID - Type Unspecified
F72406Medicare UPIN