Provider Demographics
NPI:1790996791
Name:GLORIA M MERCADO JIMENEZ
Entity Type:Organization
Organization Name:GLORIA M MERCADO JIMENEZ
Other - Org Name:FARMACIA GLORIANA AND LABORATORIO CLINICO LAS MERCEDES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-895-6216
Mailing Address - Street 1:CARR. #2 KM 96.8
Mailing Address - Street 2:BO. COCOS
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678
Mailing Address - Country:US
Mailing Address - Phone:787-895-6216
Mailing Address - Fax:787-895-6216
Practice Address - Street 1:CARR. #2 KM 96.8
Practice Address - Street 2:BO. COCOS
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-895-6216
Practice Address - Fax:787-895-6216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR893291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031131Medicare PIN