Provider Demographics
NPI:1639959901
Name:ZENGOTITA MERCADO, LUIS RENE
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:RENE
Last Name:ZENGOTITA MERCADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SANTA RITA 3 1262 CALLE SAN FRANCISCO DE ASIS
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2502
Mailing Address - Country:US
Mailing Address - Phone:787-901-1583
Mailing Address - Fax:
Practice Address - Street 1:URB. SANTA RITA 3 1262 CALLE SAN FRANCISCO DE ASIS
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-901-1583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program