Provider Demographics
NPI:1942487855
Name:ANTOMMARCHI, MELBA IRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MELBA
Middle Name:IRIS
Last Name:ANTOMMARCHI
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:PO BOX 560999
Mailing Address - Street 2:
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-3999
Mailing Address - Country:US
Mailing Address - Phone:787-675-2407
Mailing Address - Fax:
Practice Address - Street 1:DEL RIO STREET BO QUEBRADAS
Practice Address - Street 2:
Practice Address - City:GUAYANILLA
Practice Address - State:PR
Practice Address - Zip Code:00656-3999
Practice Address - Country:US
Practice Address - Phone:787-675-2407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16931175L00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1878Medicaid
PR1878Medicaid
PR1878Medicare UPIN
PR1878Medicare PIN