Provider Demographics
NPI:1679689624
Name:MERCADO PESANTE, PEDRO FRANCISCO
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:FRANCISCO
Last Name:MERCADO PESANTE
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:C-19 BLOQ 20-6 VILLA CAROLINA
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985
Mailing Address - Country:US
Mailing Address - Phone:787-646-4790
Mailing Address - Fax:787-768-7591
Practice Address - Street 1:C-19 BLOQ 20-6 VILLA CAROLINA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-646-4790
Practice Address - Fax:787-768-7591
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR57516Medicare ID - Type Unspecified