Provider Demographics
NPI:1225271612
Name:DE JESUS MELENDEZ, JOSE R (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:DE JESUS MELENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:R
Other - Last Name:DE JESUS MELENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:UNIVERSITY SCIENCE CAMPUS
Mailing Address - Street 2:RCM PO 365067
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-5067
Mailing Address - Country:US
Mailing Address - Phone:787-758-2525
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY SCIENCE CAMPUS
Practice Address - Street 2:RCM PO 365067
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-5067
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17551207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology