Provider Demographics
NPI:1497836993
Name:MELENDEZ, JORGE SIGFRIDO (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:SIGFRIDO
Last Name:MELENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 AVE ESMERALDA
Mailing Address - Street 2:URB.MUNOZ RIVERA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4429
Mailing Address - Country:US
Mailing Address - Phone:787-720-3234
Mailing Address - Fax:787-272-9729
Practice Address - Street 1:59 AVE ESMERALDA
Practice Address - Street 2:URB.MUNOZ RIVERA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4429
Practice Address - Country:US
Practice Address - Phone:787-720-3234
Practice Address - Fax:787-272-9729
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12322207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH26840Medicare UPIN
PR0020107Medicare ID - Type Unspecified