Healthcare Provider Details

I. General information

NPI: 1922836592
Provider Name (Legal Business Name): JEFRY MEJIA MERCEDES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/10/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 14 BARRIO RINCON
CAYEY PR
00737
US

IV. Provider business mailing address

VISTAS DE RIO GRANDE 2 423
RIO GRANDE PR
00745
US

V. Phone/Fax

Practice location:
  • Phone: 787-535-1001
  • Fax:
Mailing address:
  • Phone: 787-238-4180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17225I
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number37602
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: