MEDICARE: DR. EDNA GRISELLE MELENDEZ REYES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	10454	PR

General Provider Information

NPI Number	:	1922091784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDNA GRISELLE MELENDEZ REYES MD

Provider Business Mailing Address
First Line	:	PO BOX 70344
Second Line	:	PMB 203
City	:	SAN JUAN
State	:	PR
Zip	:	00936-8344
Country	:	US
Telephone Number	:	787-286-9055
Fax Number	:

Provider Business Practice Location Address
First Line	:	C/Y #26 URB. MARIOLGA
Second Line	:	AVE. LUIS MUNOZ MARIN
City	:	CAGUAS
State	:	PR
Zip	:	00725-0000
Country	:	US
Telephone Number	:	787-286-9055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	12/15/2009

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