Provider Demographics
NPI:1326037888
Name:MELPO CSP
Entity Type:Organization
Organization Name:MELPO CSP
Other - Org Name:DR LUIS H MELENDEZ POVENTUN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:H
Authorized Official - Last Name:MELENDEZ POVENTUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-547-3933
Mailing Address - Street 1:112 CALLE ARZUAGA
Mailing Address - Street 2:SUITE 605
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925-3321
Mailing Address - Country:US
Mailing Address - Phone:787-765-3164
Mailing Address - Fax:787-763-0200
Practice Address - Street 1:112 CALLE ARZUAGA
Practice Address - Street 2:SUITE 605
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-3321
Practice Address - Country:US
Practice Address - Phone:787-765-3164
Practice Address - Fax:787-763-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E31426Medicare UPIN