Provider Demographics
NPI:1992919435
Name:MERCEDES, MAIRA A (MD)
Entity type:Individual
Prefix:DR
First Name:MAIRA
Middle Name:A
Last Name:MERCEDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:VILLA DEL PARQUE APT 12-H
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909
Mailing Address - Country:US
Mailing Address - Phone:787-268-1284
Mailing Address - Fax:
Practice Address - Street 1:CARR. # 2 CARCEL DE MUJERES VEGA ALTA
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-883-3065
Practice Address - Fax:787-883-5110
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR11229363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical