Healthcare Provider Details

I. General information

NPI: 1669849709
Provider Name (Legal Business Name): FERNANDO MELENDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 11/13/2022
Certification Date: 11/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CARR 2 # KM CRUCE DAVILA
BARCELONETA PR
00617-3338
US

IV. Provider business mailing address

PO BOX 2045
BARCELONETA PR
00617-2045
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-4412
  • Fax:
Mailing address:
  • Phone: 787-846-4412
  • Fax: 787-846-4431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20256
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: