Provider Demographics
NPI:1659387736
Name:MERCADO, GLORIA A
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:A
Last Name:MERCADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 GARNET CIR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2997
Mailing Address - Country:US
Mailing Address - Phone:954-349-7321
Mailing Address - Fax:954-449-0528
Practice Address - Street 1:820 GARNET CIR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2997
Practice Address - Country:US
Practice Address - Phone:954-349-7321
Practice Address - Fax:954-449-0528
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management