1477616258 NPI number — NIVIANA ADELMARY YAMBO-MERCADO O.D.

Table of content: NIVIANA ADELMARY YAMBO-MERCADO O.D. (NPI 1477616258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477616258 NPI number — NIVIANA ADELMARY YAMBO-MERCADO O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YAMBO-MERCADO
Provider First Name:
NIVIANA
Provider Middle Name:
ADELMARY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

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:
1477616258
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MANSION REAL
Provider Second Line Business Mailing Address:
223 ISABEL ST.
Provider Business Mailing Address City Name:
COTO LAUREL
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00780-2601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-840-4646
Provider Business Mailing Address Fax Number:
787-840-4646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1718 CARR 506
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
COTO LAUREL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00780-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-840-4646
Provider Business Practice Location Address Fax Number:
787-840-4646
Provider Enumeration Date:
12/19/2006

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: 152W00000X , with the licence number:  599 , 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)





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