Provider Demographics
NPI:1568448975
Name:MELENDEZ, LOURDES AIXA (MD)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:AIXA
Last Name:MELENDEZ
Suffix:
Gender:F
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:CALLE 15-Z5-3
Mailing Address - Street 2:TURABO GARDENS
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-646-5984
Mailing Address - Fax:787-734-4690
Practice Address - Street 1:TURABO GARDENS
Practice Address - Street 2:CALLE 15-Z5-3
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-646-5984
Practice Address - Fax:787-734-4690
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14556208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21293Medicare ID - Type Unspecified
PRH-79750Medicare UPIN