Provider Demographics
NPI:1942365655
Name:MERCADO, JOSE ANGEL (MS)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ANGEL
Last Name:MERCADO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CALLE DE SAN SEBASTIAN APT E8
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-1211
Mailing Address - Country:US
Mailing Address - Phone:787-692-2777
Mailing Address - Fax:
Practice Address - Street 1:400 AVE DOMENECH
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3710
Practice Address - Country:US
Practice Address - Phone:787-250-7471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR155231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist