Provider Demographics
NPI:1659016632
Name:OTERO-MERCADO, VERONICA ALEXANDRA (1283 PA)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:ALEXANDRA
Last Name:OTERO-MERCADO
Suffix:
Gender:F
Credentials:1283 PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:L24 AVE LINCOLN
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3947
Mailing Address - Country:US
Mailing Address - Phone:787-409-4712
Mailing Address - Fax:
Practice Address - Street 1:L24 AVE LINCOLN
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-3947
Practice Address - Country:US
Practice Address - Phone:787-409-4712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1283363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant