Healthcare Provider Details

I. General information

NPI: 1215873229
Provider Name (Legal Business Name): MISAEL ABDIAS MELENDEZ LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VALLEY HILLS PROFESSIONAL CENTER SUITE #5 CARR. 402 KM 2.9
ANASCO PR
00610-2017
US

IV. Provider business mailing address

HC 3 BOX 33163
AGUADILLA PR
00603-9411
US

V. Phone/Fax

Practice location:
  • Phone: 939-376-1015
  • Fax:
Mailing address:
  • Phone: 939-376-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15744
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: