1144227869 NPI number — DR. LUIS M MERCADO MD

Table of content: DR. LUIS M MERCADO MD (NPI 1144227869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144227869 NPI number — DR. LUIS M MERCADO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERCADO
Provider First Name:
LUIS
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144227869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1895
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN GERMAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00683-1895
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-892-4357
Provider Business Mailing Address Fax Number:
787-659-7120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE. INTERAMERICANA #153
Provider Second Line Business Practice Location Address:
ESQ CHILIN QUINONES EDIF SAN JOSE #3
Provider Business Practice Location Address City Name:
SAN GERMAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-892-4357
Provider Business Practice Location Address Fax Number:
787-659-7120
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  11063 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 660564140 . This is a "COSVI" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 212828 . This is a "UTI" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 11063 . This is a "LICENCIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6830010 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7071 . This is a "INTERNATIONAL MEDICAL CAR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: PE4493 . This is a "PAN AMERICAN LIFE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 83684 . This is a "TRILES" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 064911 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 100003W . This is a "MEDICARE Y MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: DM106658 . This is a "ASSMCA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1066A . This is a "PREFERED MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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