Provider Demographics
NPI:1275082661
Name:LOPEZ MERCADO, MELANIE (LND, RDN)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:LOPEZ MERCADO
Suffix:
Gender:F
Credentials:LND, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EXT SAN JOSE 2
Mailing Address - Street 2:352 CALLE 11
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637
Mailing Address - Country:US
Mailing Address - Phone:787-538-5571
Mailing Address - Fax:
Practice Address - Street 1:COND WESTERNLAKE
Practice Address - Street 2:AVE ALGARROBO APT 802-A
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682
Practice Address - Country:US
Practice Address - Phone:787-538-5571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1990133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist