Provider Demographics
NPI:1235566928
Name:MELENDEZ LEBRON, CORALYS (MD)
Entity Type:Individual
Prefix:
First Name:CORALYS
Middle Name:
Last Name:MELENDEZ LEBRON
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:C10 CAMINO DE LIRIOS
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3966
Mailing Address - Country:US
Mailing Address - Phone:787-431-2461
Mailing Address - Fax:
Practice Address - Street 1:C10 CAMINO DE LIRIOS
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3966
Practice Address - Country:US
Practice Address - Phone:787-431-2461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR29657R208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice