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General NPI Number Information
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NPI Number | 1427948017
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Entity Type | Individual
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Provider Name | KERISHA MARLY MENDEZ GONZALEZ MD, PA
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Gender | Female
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | CARR. 417 KM 4.2 BO. MAMEY EDIFICIO PALMA REAL
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City | AGUADA
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State | PR
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Zip | 00602-0000
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Country | US
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Telephone | 787-477-0342
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Fax |
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Provider Business Mailing Address
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Address Line | HC 2 BOX 120694
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City | MOCA
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State | PR
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Zip | 00676-8369
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Country | US
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Telephone | 787-231-2720
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2481-PA
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License Number State | PR
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