Healthcare Provider Details

I. General information

NPI: 1013140292
Provider Name (Legal Business Name): ILEANA EILEEN OCASIO MELENDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 AVE AMERICO MIRANDA
SAN JUAN PR
00921-2842
US

IV. Provider business mailing address

PO BOX 365067
SAN JUAN PR
00936-5067
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-7908
  • Fax:
Mailing address:
  • Phone: 787-777-3535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number18534
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: