Provider Demographics
NPI:1174761746
Name:PORTALATIN MERCADO, JAVIER SR (PHD)
Entity type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:
Last Name:PORTALATIN MERCADO
Suffix:SR
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 440
Mailing Address - Street 2:
Mailing Address - City:ADJUNTAS
Mailing Address - State:PR
Mailing Address - Zip Code:00601-0440
Mailing Address - Country:US
Mailing Address - Phone:787-829-0648
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA LAGO GARZAS KM 1.2
Practice Address - Street 2:
Practice Address - City:ADJUNTAS
Practice Address - State:PR
Practice Address - Zip Code:00601-0440
Practice Address - Country:US
Practice Address - Phone:787-829-0648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3146103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist