Provider Demographics
NPI:1205227626
Name:MELENDEZ MELENDEZ, JOSE A
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:MELENDEZ MELENDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GG3 CALLE 24
Mailing Address - Street 2:URB VILLAS DE CASTRO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-4662
Mailing Address - Country:US
Mailing Address - Phone:787-590-7595
Mailing Address - Fax:
Practice Address - Street 1:CARR 848 KM .07
Practice Address - Street 2:SAINT JSUT
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00978
Practice Address - Country:US
Practice Address - Phone:787-761-0715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1925101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1925OtherCOUNSELOR LICENCE