Provider Demographics
NPI:1548973019
Name:MERCADO VALENTIN, NILKA MARIE (TS)
Entity type:Individual
Prefix:
First Name:NILKA
Middle Name:MARIE
Last Name:MERCADO VALENTIN
Suffix:
Gender:F
Credentials:TS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1794
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-1794
Mailing Address - Country:US
Mailing Address - Phone:787-206-8744
Mailing Address - Fax:
Practice Address - Street 1:11 CALLE FRANCISCO ORTIZ LEBRON
Practice Address - Street 2:
Practice Address - City:PATILLAS
Practice Address - State:PR
Practice Address - Zip Code:00723-2813
Practice Address - Country:US
Practice Address - Phone:787-384-8452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR160411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0123456789OtherNOT YET HAVE OTHER ID