Provider Demographics
NPI:1073738555
Name:MELENDEZ, JESSICA
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CALLE LIRA
Mailing Address - Street 2:JARDINES DE BAYAMONTE
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-6641
Mailing Address - Country:US
Mailing Address - Phone:787-763-5308
Mailing Address - Fax:787-763-5312
Practice Address - Street 1:120 CALLE LIRA
Practice Address - Street 2:JARDINES DE BAYAMONTE
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-6641
Practice Address - Country:US
Practice Address - Phone:787-763-5308
Practice Address - Fax:787-763-5312
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006206183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR006206OtherTECHNICIAN LICENSE