Provider Demographics
NPI:1316024482
Name:MELLA, ENRIQUE SR (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:MELLA
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3795
Mailing Address - Country:US
Mailing Address - Phone:305-576-6611
Mailing Address - Fax:305-576-0008
Practice Address - Street 1:3601 FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3795
Practice Address - Country:US
Practice Address - Phone:305-576-6611
Practice Address - Fax:305-576-0008
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME17229207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376865100Medicaid
FL376865100Medicaid