Provider Demographics
NPI:1609051424
Name:ALFREDO MERCADO SANTANA
Entity Type:Organization
Organization Name:ALFREDO MERCADO SANTANA
Other - Org Name:MERCADO MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:MERCADO
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-892-1599
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. UNIVERDIDAD 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
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