Healthcare Provider Details

I. General information

NPI: 1386882520
Provider Name (Legal Business Name): NICOLAS A. MELGAREJO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 W. HOUSTON ST. SUITE #808
SAN ANTONIO TX
78205
US

IV. Provider business mailing address

8042 WURZBACH RD. #280
SAN ANTONIO TX
78229-3863
US

V. Phone/Fax

Practice location:
  • Phone: 210-224-9616
  • Fax: 210-224-5822
Mailing address:
  • Phone: 210-224-9616
  • Fax: 210-224-5822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN1763
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberN1763
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: