Provider Demographics
NPI:1285825794
Name:MERCADO, LUZ IVETTE
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:IVETTE
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:HC 3 BOX 8910
Mailing Address - Street 2:BO HELECHAL
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794
Mailing Address - Country:US
Mailing Address - Phone:787-615-1329
Mailing Address - Fax:787-786-0591
Practice Address - Street 1:HC 3 BOX 8910
Practice Address - Street 2:BO HELECHAL
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-9528
Practice Address - Country:US
Practice Address - Phone:787-615-1329
Practice Address - Fax:787-786-0591
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6484183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician