Provider Demographics
NPI:1164531059
Name:MELENDEZ, MELVIN (MD)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 223 SC1353 RD 19
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-793-2462
Mailing Address - Fax:787-774-1615
Practice Address - Street 1:TORRE DEL METROPOLITANO 1789 SUITE 209
Practice Address - Street 2:CARR 21 LAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-793-2462
Practice Address - Fax:787-774-1615
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11617207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR601120OtherMEDICARE Y MUCHO MAS
PR064521OtherCRUZ AZUL
PR84448MEOtherTRIPLE S
PR2514OtherINTERNTIONAL MEDICAL CAR
PRG41626Medicare UPIN
PR84448Medicare UPIN