Provider Demographics
NPI:1265203467
Name:RUIZ MERCADO, LEMUEL
Entity type:Individual
Prefix:
First Name:LEMUEL
Middle Name:
Last Name:RUIZ MERCADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MACHUCHAL WD SABANA GRANDE, PR
Mailing Address - Street 2:BO MACHUCHAL WD SABANA GRANDE, PR
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637
Mailing Address - Country:US
Mailing Address - Phone:787-430-0488
Mailing Address - Fax:
Practice Address - Street 1:PR 368 KM 2.6 INT LOT 1
Practice Address - Street 2:BO MACHUCHAL WD SABANA GRANDE, PR
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637
Practice Address - Country:US
Practice Address - Phone:787-430-0488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR160011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical