Provider Demographics
NPI:1487199865
Name:LUIS MELERO ROSA LLC
Entity Type:Organization
Organization Name:LUIS MELERO ROSA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICO
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:MELERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-214-5507
Mailing Address - Street 1:2 VICTOR ROJAS
Mailing Address - Street 2:CARR 129
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-650-4799
Mailing Address - Fax:787-933-4899
Practice Address - Street 1:129 CALLE 2
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-3038
Practice Address - Country:US
Practice Address - Phone:787-214-5507
Practice Address - Fax:787-933-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16548261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0028897Medicare UPIN