Provider Demographics
NPI:1881738078
Name:MELENDEZ LUCIANO, FERDINAND (OCCUPATIONAL THERAPI)
Entity type:Individual
Prefix:
First Name:FERDINAND
Middle Name:
Last Name:MELENDEZ LUCIANO
Suffix:
Gender:M
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2K33 CALLE 64
Mailing Address - Street 2:URB. METROPOLIS
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-7531
Mailing Address - Country:US
Mailing Address - Phone:787-319-1640
Mailing Address - Fax:
Practice Address - Street 1:2K33 CALLE 64
Practice Address - Street 2:URB. METROPOLIS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-7531
Practice Address - Country:US
Practice Address - Phone:787-319-1640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR494225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRP68156Medicare UPIN