Provider Demographics
NPI:1194363655
Name:CRUZ GARCIA, MERCEDES DEL MAR
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:DEL MAR
Last Name:CRUZ GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE CJ 3 CARLOS J LOZADA
Mailing Address - Street 2:URB JARDINES DE CAGUAS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2515
Mailing Address - Country:US
Mailing Address - Phone:787-310-8196
Mailing Address - Fax:
Practice Address - Street 1:CUIDAD JARDIN CALLE LILA 112
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-9999
Practice Address - Country:US
Practice Address - Phone:787-310-8196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR103K00000XOtherBEHAVIOR ANALYST