Provider Demographics
NPI:1700825130
Name:JIMENEZ MERCADO, ANGEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:M
Last Name:JIMENEZ MERCADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42905 CARR 482
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-9319
Mailing Address - Country:US
Mailing Address - Phone:787-895-1069
Mailing Address - Fax:787-895-1069
Practice Address - Street 1:42905 CARR 482
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-9319
Practice Address - Country:US
Practice Address - Phone:787-895-1069
Practice Address - Fax:787-895-1069
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9560207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
88059Medicare ID - Type Unspecified
E59256Medicare UPIN