Provider Demographics
NPI:1750640447
Name:MERCADO MORALES, NEYSA (M D)
Entity Type:Individual
Prefix:
First Name:NEYSA
Middle Name:
Last Name:MERCADO MORALES
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE GAUTIER BENITEZ
Mailing Address - Street 2:C8
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-746-2606
Mailing Address - Fax:
Practice Address - Street 1:AVE GAUTIER BENITEZ
Practice Address - Street 2:CONSOLIDATED MALL
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726
Practice Address - Country:US
Practice Address - Phone:787-746-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18807261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care