Provider Demographics
NPI:1871751909
Name:ORTIZ MERCADO, JOSE M (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:ORTIZ MERCADO
Suffix:
Gender:M
Credentials:PHD
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 993
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-0993
Mailing Address - Country:US
Mailing Address - Phone:787-209-1483
Mailing Address - Fax:
Practice Address - Street 1:CARR. 402 KM 1.8
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-0061
Practice Address - Country:US
Practice Address - Phone:787-209-1483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3018103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3018OtherLICENCIA PERMANENTE