Provider Demographics
NPI:1023157203
Name:MELENDEZ, LUIS (CFA)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:M
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 RIVERPLACE BLVD
Mailing Address - Street 2:SUITE# 610
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-9069
Mailing Address - Country:US
Mailing Address - Phone:904-962-8932
Mailing Address - Fax:
Practice Address - Street 1:1401 RIVERPLACE BLVD
Practice Address - Street 2:# 610
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-9069
Practice Address - Country:US
Practice Address - Phone:904-962-8932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL97966246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant