Healthcare Provider Details

I. General information

NPI: 1750080552
Provider Name (Legal Business Name): MS. ANTOINETTE BELTRAN-MELENDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 03/01/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MAYAGUEZ MEDICAL CENTER CARRETERA 2 KM157 SABALOS
MAYAGUEZ PR
00680-0068
US

IV. Provider business mailing address

4023 URB MONTE BELLO
HORMIGUEROS PR
00660
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-0663
  • Fax:
Mailing address:
  • Phone: 787-421-8812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6738
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: