Provider Demographics
NPI:1669435459
Name:RAIMUNDI MELENDEZ, JOSE L (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:RAIMUNDI MELENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0441
Mailing Address - Country:US
Mailing Address - Phone:787-884-6005
Mailing Address - Fax:787-778-3875
Practice Address - Street 1:URB FLAMBOYAN
Practice Address - Street 2:H5 CALLE 16
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-6005
Practice Address - Fax:787-884-6005
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR105652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0088540Medicare ID - Type Unspecified