Healthcare Provider Details

I. General information

NPI: 1972515856
Provider Name (Legal Business Name): WILLIAM GRASSETTE MELENDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3474 PASEO CAMARON 3RA SECCION LEVITTOWN
TOA BAJA PR
00949-3634
US

IV. Provider business mailing address

229 CALLE DEL PARQUE COND. PARQUE CENTRAL APT. 904
SAN JUAN PR
00912-3223
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-2521
  • Fax: 787-795-2289
Mailing address:
  • Phone: 787-795-2935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number10816
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: