Provider Demographics
NPI:1962618587
Name:LOZADA MERCADO, MARIA VICTORIA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:VICTORIA
Last Name:LOZADA MERCADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1631
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-1631
Mailing Address - Country:US
Mailing Address - Phone:787-673-1832
Mailing Address - Fax:
Practice Address - Street 1:117 CALLE RAMON VALDES
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-3839
Practice Address - Country:US
Practice Address - Phone:787-832-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12399208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88961Medicare ID - Type Unspecified