Healthcare Provider Details

I. General information

NPI: 1891761896
Provider Name (Legal Business Name): ELIUT MELENDEZ ORTIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 12/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 CALLE DE DIEGO TORRE SAN FRANCISCO, SUITE 509
SAN JUAN PR
00923-3003
US

IV. Provider business mailing address

PO BOX 362186
SAN JUAN PR
00936-2186
US

V. Phone/Fax

Practice location:
  • Phone: 787-282-3000
  • Fax: 787-767-2272
Mailing address:
  • Phone: 787-282-3000
  • Fax: 787-767-2272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10154
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: