Healthcare Provider Details

I. General information

NPI: 1437888906
Provider Name (Legal Business Name): DANIEL FEDERICO MELENDEZ-MORAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 METROS NORTE IGLESIA DE SAN ISIDRO DE HEREDIA, POR
SAN ISIDRO HEREDIA
40601
CR

IV. Provider business mailing address

500 METROS NORTE IGLESIA DE SAN ISIDRO DE HEREDIA, POR
SAN ISIDRO HEREDIA
40601
CR

V. Phone/Fax

Practice location:
  • Phone: 348-882-6735
  • Fax:
Mailing address:
  • Phone:
  • 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: