Healthcare Provider Details

I. General information

NPI: 1235941337
Provider Name (Legal Business Name): MELANIE CINTRON MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR.174 KM. 10.2 SECTOR LA MORENITA BO .GUARAGUAO
BAYAMON PR
00956
US

IV. Provider business mailing address

HC 69 BOX 15544
BAYAMON PR
00956-9872
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-7383
  • Fax: 787-780-7389
Mailing address:
  • Phone: 787-780-7383
  • Fax: 787-780-7389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number09-F-2536
License Number StatePR

VII. Legacy identifiers

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

# 1
Identifier039961200
Identifier TypeMEDICAID
Identifier StatePR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: