Healthcare Provider Details

I. General information

NPI: 1942114822
Provider Name (Legal Business Name): JOSE DAVID DIPRE MELENDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12555 ORANGE DR STE 4214
DAVIE FL
33330-4304
US

IV. Provider business mailing address

12555 ORANGE DR STE 4214
DAVIE FL
33330-4304
US

V. Phone/Fax

Practice location:
  • Phone: 786-856-2117
  • Fax:
Mailing address:
  • Phone: 786-856-2117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA100449
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: