Healthcare Provider Details

I. General information

NPI: 1033152095
Provider Name (Legal Business Name): GADIEL MELENDEZ PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIFICIO CENTURION PISO 3 CARRETERA #2 KM. 11.8
BAYAMON PR
00961
US

IV. Provider business mailing address

11 ST. F-5 URB. VILLAS DEL RIO
BAYAMON PR
00959
US

V. Phone/Fax

Practice location:
  • Phone: 787-995-2700
  • Fax: 787-995-2702
Mailing address:
  • Phone: 787-789-5618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2129
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: