Provider Demographics
NPI:1902266315
Name:MERCADO VELEZ, LYVETTE
Entity Type:Individual
Prefix:
First Name:LYVETTE
Middle Name:
Last Name:MERCADO VELEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7A COND. VILLA DEL PARQUE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909
Mailing Address - Country:US
Mailing Address - Phone:787-475-7393
Mailing Address - Fax:
Practice Address - Street 1:CALLE MANUEL F. ROSSI ESQ. ISABEL II
Practice Address - Street 2:VARMED HEALTH CENTER BUILDING B, META MED LLC
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-988-2027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR86021018133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered