Provider Demographics
NPI:1093871709
Name:MELENDEZ CABRERO, JOSEFINA (PHD)
Entity Type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:
Last Name:MELENDEZ CABRERO
Suffix:
Gender:F
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 194589
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-4589
Mailing Address - Country:US
Mailing Address - Phone:939-645-8154
Mailing Address - Fax:787-281-6017
Practice Address - Street 1:735 AVE PONCE DE LEON, TORRE MEDICA AUXILIO MUTUO 602
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:939-645-8154
Practice Address - Fax:939-437-4397
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2764103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0059777Medicare UPIN