Provider Demographics
NPI:1659488773
Name:MENDEZ, BRENDA MERCADO (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:MERCADO
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ST.126 BX6 VALLE ARRIBA HTS.
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983
Mailing Address - Country:US
Mailing Address - Phone:787-762-5538
Mailing Address - Fax:787-762-5538
Practice Address - Street 1:AVE.ROBERTO CLEMENTE BLOQUE129#27 VILLA CAROLINA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984
Practice Address - Country:US
Practice Address - Phone:787-752-0984
Practice Address - Fax:787-752-0984
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11684208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-60149Medicare UPIN