Provider Demographics
NPI:1821184185
Name:MERCADO, LIDIA (LCDA)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:
Last Name:MERCADO
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE BRUMBAUGH 1055
Mailing Address - Street 2:
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00925-2932
Mailing Address - Country:US
Mailing Address - Phone:787-765-3735
Mailing Address - Fax:787-765-3735
Practice Address - Street 1:CALLE BRUMBAUGH 1055
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00925-2916
Practice Address - Country:US
Practice Address - Phone:787-765-3735
Practice Address - Fax:787-765-3735
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1528246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038007Medicare ID - Type Unspecified