Provider Demographics
NPI:1750826681
Name:MERCADO, MARILIS (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARILIS
Middle Name:
Last Name:MERCADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1315
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-1315
Mailing Address - Country:US
Mailing Address - Phone:787-487-9056
Mailing Address - Fax:
Practice Address - Street 1:20 CALLE PACHECO S
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3578
Practice Address - Country:US
Practice Address - Phone:787-487-9056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR82861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical