Provider Demographics
NPI:1780718072
Name:MELENDEZ, JOSE R (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:MELENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:R
Other - Last Name:MELENDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3636 CALLE CUMBRE
Mailing Address - Street 2:URB. EL MONTE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4834
Mailing Address - Country:US
Mailing Address - Phone:787-643-6152
Mailing Address - Fax:
Practice Address - Street 1:3636 CALLE CUMBRE
Practice Address - Street 2:URB. EL MONTE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4834
Practice Address - Country:US
Practice Address - Phone:787-643-6152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6153208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics