Provider Demographics
NPI:1609056753
Name:PADRON, MERCEDES (DO)
Entity Type:Individual
Prefix:MRS
First Name:MERCEDES
Middle Name:
Last Name:PADRON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 W 76TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1834
Mailing Address - Country:US
Mailing Address - Phone:305-698-3030
Mailing Address - Fax:305-698-3040
Practice Address - Street 1:2095 W 76TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1834
Practice Address - Country:US
Practice Address - Phone:305-698-3030
Practice Address - Fax:305-698-3040
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO 5503156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician