Provider Demographics
NPI:1518508944
Name:RIOS-MERCADO, ILEANA (SLP)
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:RIOS-MERCADO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:REPTO TERESITA
Mailing Address - Street 2:N9 CALLE 7
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3680
Mailing Address - Country:US
Mailing Address - Phone:787-231-3281
Mailing Address - Fax:
Practice Address - Street 1:16-20 AVE AGUAS BUENAS
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6691
Practice Address - Country:US
Practice Address - Phone:787-525-2033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR583235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist