Provider Demographics
NPI:1639906209
Name:RODRIGUEZ MERCADO, STEPHANIE VICTORIA (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:VICTORIA
Last Name:RODRIGUEZ MERCADO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 HUDSON BLVD APT 203
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4771
Mailing Address - Country:US
Mailing Address - Phone:787-241-0209
Mailing Address - Fax:
Practice Address - Street 1:2970 HUDSON BLVD APT 203
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-4771
Practice Address - Country:US
Practice Address - Phone:787-241-0209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16189111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor