Healthcare Provider Details

I. General information

NPI: 1508307596
Provider Name (Legal Business Name): DRA. SUHEIDI MEDINA-MERCADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CALLE LUIS MOLINA
BARCELONETA PR
00617-3449
US

IV. Provider business mailing address

84 CALLE ATIENZA URB PASEOS REALES
SAN ANTONIO PR
00690-1410
US

V. Phone/Fax

Practice location:
  • Phone: 787-449-4128
  • Fax:
Mailing address:
  • Phone: 787-449-4128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health
License Number5826
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MISS SUHEIDI MEDINA-MERCADO
Title or Position: OWNER
Credential: PSYD
Phone: 787-449-4128