Provider Demographics
NPI:1104405539
Name:TOLEDO MERCADO, KARLA R
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:R
Last Name:TOLEDO MERCADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COND JARD SAN FRANCISCO APT 301
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6421
Mailing Address - Country:US
Mailing Address - Phone:939-400-7086
Mailing Address - Fax:
Practice Address - Street 1:2 COND JARD SAN FRANCISCO APT 301
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6421
Practice Address - Country:US
Practice Address - Phone:939-400-7086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-04
Last Update Date:2021-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4906540OtherLICENSE NUMBER