Provider Demographics
NPI:1477071173
Name:MELENDEZ-MORALES, MARIA E (RDN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:MELENDEZ-MORALES
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VILLA CAROLINA
Mailing Address - Street 2:136-19 CALLE 405
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-4008
Mailing Address - Country:US
Mailing Address - Phone:787-376-2115
Mailing Address - Fax:939-202-7294
Practice Address - Street 1:GUAYNABO MEDICAL MALL SUITE 106
Practice Address - Street 2:140 AVE LAS CUMBRES
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-710-2532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1911133VN1005X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1911OtherOFFCIE OF REGULARION AND CERTIFICATION OF HEALTH PROFESSIONALS