Provider Demographics
NPI:1992430441
Name:ESPINAL MERCADO, CARLOS RAFAEL
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:RAFAEL
Last Name:ESPINAL MERCADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 NE 122ND ST # 751
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5615
Mailing Address - Country:US
Mailing Address - Phone:347-440-7975
Mailing Address - Fax:
Practice Address - Street 1:751 NE 122ND ST # 751
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5615
Practice Address - Country:US
Practice Address - Phone:347-440-7975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN273461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty