Provider Demographics
NPI:1073512943
Name:MELENDEZ-ROSA, MYRIAM I (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRIAM
Middle Name:I
Last Name:MELENDEZ-ROSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1439
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-1439
Mailing Address - Country:US
Mailing Address - Phone:787-433-1205
Mailing Address - Fax:787-251-5969
Practice Address - Street 1:NO.11 PALMER ST.
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6341
Practice Address - Country:US
Practice Address - Phone:787-780-7303
Practice Address - Fax:787-251-5969
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10597207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0082895OtherPTAN
PRF26900Medicare UPIN