=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003464785
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MV HEALTH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2019
-----------------------------------------------------
Last Update Date | 08/27/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 FELISA RINCON DE GAUTIER AVENUE
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-365-2102
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CIUDADELA 1509 PONCE DE LEON 1434
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-365-2102
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HECTOR MELENDEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-365-2102
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------