Provider Demographics
NPI:1275637431
Name:ALICEA MELERO, JOSE EMANUEL
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:EMANUEL
Last Name:ALICEA MELERO
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 1:519 CAMINO MIRAMONTES
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-5265
Mailing Address - Country:US
Mailing Address - Phone:787-319-9724
Mailing Address - Fax:
Practice Address - Street 1:CALLE JOSE C VAZQUEZ
Practice Address - Street 2:BO CAONILLAS
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-0070
Practice Address - Country:US
Practice Address - Phone:787-735-7969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9552207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0081685Medicare ID - Type Unspecified
PRE81918Medicare UPIN