Provider Demographics
NPI:1033532379
Name:MERCADO-RIVERA, RODOLFO SR (MA)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:MERCADO-RIVERA
Suffix:SR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC-5 BOX93526
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9611
Mailing Address - Country:US
Mailing Address - Phone:787-374-0137
Mailing Address - Fax:
Practice Address - Street 1:CARR 877 KM 1.6 CAMINO LOS LOMOS
Practice Address - Street 2:RIO PIERDRAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-374-0137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4291103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist