Provider Demographics
NPI:1801461470
Name:MELENDEZ ORTIZ, PAULO ABNIER
Entity type:Individual
Prefix:
First Name:PAULO
Middle Name:ABNIER
Last Name:MELENDEZ ORTIZ
Suffix:
Gender:M
Credentials:
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 91
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-0091
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARR 164 SECTOR EL DESVIO
Practice Address - Street 2:BO ACHIOTE
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-0515
Practice Address - Country:US
Practice Address - Phone:787-869-1290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22952208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice