Provider Demographics
NPI:1659921591
Name:ERAZO, MELISSA (OPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ERAZO
Suffix:
Gender:F
Credentials:OPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 8 BOX 68920
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-6125
Mailing Address - Country:US
Mailing Address - Phone:787-815-0169
Mailing Address - Fax:787-815-4466
Practice Address - Street 1:CARR. 167 URB. RIVERVIEW
Practice Address - Street 2:CALLE#36 ZA-19
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-780-3969
Practice Address - Fax:787-780-3969
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1326156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician