Provider Demographics
NPI:1538361266
Name:RUIZ MERCADO, GLORIMAR
Entity type:Individual
Prefix:DR
First Name:GLORIMAR
Middle Name:
Last Name:RUIZ MERCADO
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 1:66 HIGHLAND RD # 1
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2311
Mailing Address - Country:US
Mailing Address - Phone:617-777-7936
Mailing Address - Fax:
Practice Address - Street 1:66 HIGHLAND RD # 1
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2311
Practice Address - Country:US
Practice Address - Phone:617-777-7936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15566171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator