Healthcare Provider Details

I. General information

NPI: 1588240360
Provider Name (Legal Business Name): MELANIO BRUCETA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5731 PALM AVE
HIALEAH FL
33012-2756
US

IV. Provider business mailing address

5731 PALM AVE
HIALEAH FL
33012-2756
US

V. Phone/Fax

Practice location:
  • Phone: 305-409-9192
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MELANIO BRUCETA
Title or Position: OWNER
Credential: APRN
Phone: 305-409-9192