Healthcare Provider Details

I. General information

NPI: 1861971962
Provider Name (Legal Business Name): JUAN GABRIEL MELENDEZ RIVERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 CALLE SANTA CRUZ STE 316
BAYAMON PR
00961-6919
US

IV. Provider business mailing address

73 CALLE SANTA CRUZ STE 316
BAYAMON PR
00961-6919
US

V. Phone/Fax

Practice location:
  • Phone: 787-483-4161
  • Fax: 414-307-9316
Mailing address:
  • Phone: 787-483-4161
  • Fax: 414-307-9316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA11685800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number24403
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD484626
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: