Healthcare Provider Details

I. General information

NPI: 1588040281
Provider Name (Legal Business Name): MELENDEZ GASTROENTEROLOGY INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4246 CARRETERA 2 KM 43
VEGA BAJA PR
00693-4128
US

IV. Provider business mailing address

4246 CARRETERA 2 KM 43
VEGA BAJA PR
00693-4128
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-7218
  • Fax:
Mailing address:
  • Phone: 787-884-7218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number16955
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number16955
License Number StatePR

VIII. Authorized Official

Name: DR. JORGE DAVID MELENDEZ HERNANDEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-308-6859