Provider Demographics
NPI:1427948017
Name:MENDEZ GONZALEZ, KERISHA MARLY (MD, PA)
Entity type:Individual
Prefix:
First Name:KERISHA
Middle Name:MARLY
Last Name:MENDEZ GONZALEZ
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:HC 2 BOX 120694
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-8369
Mailing Address - Country:US
Mailing Address - Phone:787-231-2720
Mailing Address - Fax:
Practice Address - Street 1:CARR. 417 KM 4.2 BO. MAMEY
Practice Address - Street 2:EDIFICIO PALMA REAL
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-0000
Practice Address - Country:US
Practice Address - Phone:787-477-0342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2481-PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant