Provider Demographics
NPI:1821545427
Name:SERRANO-MERCADO, MARIELY
Entity Type:Individual
Prefix:
First Name:MARIELY
Middle Name:
Last Name:SERRANO-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 1:409 BEATO FRANCISCO PALAU
Mailing Address - Street 2:URB. SAN JOSE C
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-1906
Mailing Address - Country:US
Mailing Address - Phone:787-220-5155
Mailing Address - Fax:
Practice Address - Street 1:409 CALLE BEATO FRANCISCO PALAU
Practice Address - Street 2:URB. SAN JOSE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-1906
Practice Address - Country:US
Practice Address - Phone:787-220-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001265225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist