Provider Demographics
NPI:1508307596
Name:DRA. SUHEIDI MEDINA-MERCADO
Entity Type:Organization
Organization Name:DRA. SUHEIDI MEDINA-MERCADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SUHEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA-MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-449-4128
Mailing Address - Street 1:84 CALLE ATIENZA
Mailing Address - Street 2:URB PASEOS REALES
Mailing Address - City:SAN ANTONIO
Mailing Address - State:PR
Mailing Address - Zip Code:00690-1410
Mailing Address - Country:US
Mailing Address - Phone:787-449-4128
Mailing Address - Fax:
Practice Address - Street 1:14 CALLE LUIS MOLINA
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-3449
Practice Address - Country:US
Practice Address - Phone:787-449-4128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5826261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health