Provider Demographics
NPI:1477820744
Name:MELENDEZ FUENTES, JAVIER ANTONIO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:ANTONIO
Last Name:MELENDEZ FUENTES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 15781
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-9756
Mailing Address - Country:US
Mailing Address - Phone:787-367-5844
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 15781
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-9756
Practice Address - Country:US
Practice Address - Phone:787-367-5844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3781103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical