Healthcare Provider Details

I. General information

NPI: 1154379113
Provider Name (Legal Business Name): JOSE LUIS CRUZ-MELENDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 AVE LAS AMERICAS EDF. A PORRATA PILA SUITE 301
PONCE PR
00717-2113
US

IV. Provider business mailing address

2431 LAS AMERICAS AVE. EDF. A PORRATA PILA SUITE 301
PONCE PR
00717-2115
US

V. Phone/Fax

Practice location:
  • Phone: 787-843-3538
  • Fax: 787-840-5189
Mailing address:
  • Phone: 787-843-3538
  • Fax: 787-840-5189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7029
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: