Provider Demographics
NPI:1184646911
Name:MELENDEZ TIRADO, MARIELLY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIELLY
Middle Name:
Last Name:MELENDEZ TIRADO
Suffix:
Gender:F
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:PO BOX 10329
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-1329
Mailing Address - Country:US
Mailing Address - Phone:939-439-5566
Mailing Address - Fax:787-850-0220
Practice Address - Street 1:59 AVE FONT MARTELO W
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3615
Practice Address - Country:US
Practice Address - Phone:787-850-0211
Practice Address - Fax:787-850-0220
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16254208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice