Provider Demographics
NPI:1477616258
Name:YAMBO-MERCADO, NIVIANA ADELMARY (OD)
Entity Type:Individual
Prefix:
First Name:NIVIANA
Middle Name:ADELMARY
Last Name:YAMBO-MERCADO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MANSION REAL
Mailing Address - Street 2:223 ISABEL ST.
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2601
Mailing Address - Country:US
Mailing Address - Phone:787-840-4646
Mailing Address - Fax:787-840-4646
Practice Address - Street 1:1718 CARR 506
Practice Address - Street 2:SUITE 101
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-2601
Practice Address - Country:US
Practice Address - Phone:787-840-4646
Practice Address - Fax:787-840-4646
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR599152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist