Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 16132 | PR |
NPI | 1043208432 |
---|---|
Provider Name | Dr. Diahnara Mercado Ramirez |
First Address | Anasco, PR 00610-1750 |
Second Address | Anasco, PR 00610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 23/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16132 | LIC (01) | PR |