Healthcare Provider Details

I. General information

NPI: 1134102197
Provider Name (Legal Business Name): MIYANIL HERNANDEZ MELENDEZ O.T.L.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR # 2 KM 56.9
BARCELONETA PR
00618
US

IV. Provider business mailing address

PO BOX 1621
MANATI PR
00674-1621
US

V. Phone/Fax

Practice location:
  • Phone: 787-400-0123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0999
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: