Healthcare Provider Details

I. General information

NPI: 1538081419
Provider Name (Legal Business Name): CRISTIAN ALEXANDER MELGAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9981 S HEALTHPARK DR
FORT MYERS FL
33908-3620
US

IV. Provider business mailing address

27235 LIRIOPE CT
WESLEY CHAPEL FL
33544-1822
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-5000
  • Fax:
Mailing address:
  • Phone: 813-389-6667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: