Provider Demographics
NPI:1164153151
Name:MELENDEZ VAZQUEZ, MANUEL FELIPE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:FELIPE
Last Name:MELENDEZ VAZQUEZ
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 8532
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-8532
Mailing Address - Country:US
Mailing Address - Phone:787-632-7521
Mailing Address - Fax:
Practice Address - Street 1:URB LOS SAUCES CALLE LAUREL #118
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-632-7521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7386103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty