Healthcare Provider Details

I. General information

NPI: 1699252205
Provider Name (Legal Business Name): ELIANA MARIA MELENDEZ D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N VILLA SAN MARCO DR UNIT 306
ST AUGUSTINE FL
32086-5194
US

IV. Provider business mailing address

305 N VILLA SAN MARCO DR UNIT 306
ST AUGUSTINE FL
32086-5194
US

V. Phone/Fax

Practice location:
  • Phone: 787-624-2176
  • Fax:
Mailing address:
  • Phone: 787-624-2176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH12539
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: