Provider Demographics
NPI:1730246570
Name:MERCADO, LUIS RAFAEL
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:RAFAEL
Last Name:MERCADO
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:LUIS
Other - Middle Name:RAFAEL
Other - Last Name:MERCADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:95 BARBOSA ST
Mailing Address - Street 2:ARECIBO MEDICAL PLAZA SUITE 203
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00606
Mailing Address - Country:US
Mailing Address - Phone:787-452-1277
Mailing Address - Fax:
Practice Address - Street 1:95 BARBOSA ST
Practice Address - Street 2:ARECIBO MEDICAL PLAZA SUITE 203
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00606
Practice Address - Country:US
Practice Address - Phone:787-452-1277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1331103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical