Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 18097 | PR |
NPI | 1033411426 |
---|---|
Provider Name | Juan Manuel Mercado |
First Address | Trujillo Alto, PR 00976-6089 |
Second Address | Trujillo Alto, PR 00976-6089 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2010 |
Last Update Date | 17/11/2010 |