Provider Demographics
NPI:1447556238
Name:MELENDEZ, ENID MARIA (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MRS
First Name:ENID
Middle Name:MARIA
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366879
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6879
Mailing Address - Country:US
Mailing Address - Phone:787-763-4106
Mailing Address - Fax:787-763-4074
Practice Address - Street 1:525 AVENIDA ROOSVELT, PLAZA LAS AMERICAS
Practice Address - Street 2:LA TORRE DE PLAZA, SUITE 605
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-763-4106
Practice Address - Fax:787-763-4074
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR749133N00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist