Provider Demographics
NPI:1225498892
Name:MERCADO, RUTH AMY
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:AMY
Last Name:MERCADO
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 1:4038 CALLE SANTA CATALINA
Mailing Address - Street 2:SANTA TERESITA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-4620
Mailing Address - Country:US
Mailing Address - Phone:787-204-9779
Mailing Address - Fax:
Practice Address - Street 1:4038 CALLE SANTA CATALINA
Practice Address - Street 2:SANTA TERESITA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-4620
Practice Address - Country:US
Practice Address - Phone:787-204-9779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1584174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator