Healthcare Provider Details

I. General information

NPI: 1174817449
Provider Name (Legal Business Name): AMILCAR GABRIEL RODRIGUEZ MELENDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2011
Last Update Date: 08/21/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 AVE. TITO CASTRO SUITE 802 TORRE MEDICA SAN LUCAS
PONCE PR
00716
US

IV. Provider business mailing address

PO BOX 8430
PONCE PR
00732-8430
US

V. Phone/Fax

Practice location:
  • Phone: 787-505-4555
  • Fax: 787-507-4555
Mailing address:
  • Phone: 787-505-4555
  • Fax: 787-507-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number19313
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number19313
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number19313
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: