Healthcare Provider Details

I. General information

NPI: 1649406950
Provider Name (Legal Business Name): YASSER RICARDO AWAD MELENDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 CALLE FLAMBOYAN CASA I - 10
MANATI PR
00674-5845
US

IV. Provider business mailing address

17 CALLE FLAMBOYAN CASA I - 10
MANATI PR
00674-5845
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-4715
  • Fax:
Mailing address:
  • Phone: 787-854-4715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17429
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: