Provider Demographics
NPI:1114760931
Name:MERCADO, YADIRA
Entity type:Individual
Prefix:
First Name:YADIRA
Middle Name:
Last Name: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 1:42258 CALLE ARCA DE NOE
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-9330
Mailing Address - Country:US
Mailing Address - Phone:787-501-5404
Mailing Address - Fax:
Practice Address - Street 1:42258 CALLE ARCA DE NOE
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-9330
Practice Address - Country:US
Practice Address - Phone:787-501-5404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician