Provider Demographics
NPI:1578218483
Name:MERCED, KELVIN
Entity type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:
Last Name:MERCED
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:KELVIN
Other - Middle Name:
Other - Last Name:MERCED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7105
Mailing Address - Street 2:PMB 576
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7105
Mailing Address - Country:US
Mailing Address - Phone:787-290-9609
Mailing Address - Fax:787-651-6101
Practice Address - Street 1:URB VILLA ESPERANZA
Practice Address - Street 2:CALLE 4 NUM 77
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-290-9609
Practice Address - Fax:787-651-6101
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001257101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1257OtherLICENSE