Healthcare Provider Details

I. General information

NPI: 1033532379
Provider Name (Legal Business Name): RODOLFO MERCADO-RIVERA SR. M.A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 877 KM 1.6 CAMINO LOS LOMOS RIO PIERDRAS
SAN JUAN PR
00926
US

IV. Provider business mailing address

HC-5 BOX93526
ARECIBO PR
00612-9611
US

V. Phone/Fax

Practice location:
  • Phone: 787-374-0137
  • Fax:
Mailing address:
  • Phone: 787-374-0137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4291
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: