=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043681968
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAURICIO E. MELHADO, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2015
-----------------------------------------------------
Last Update Date | 10/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3472 FOREST HILL BLVD SUITE 3B
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33406-5864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-619-3051
-----------------------------------------------------
Fax | 561-619-3055
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3472 FOREST HILL BLVD SUITE 3B
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33406-5864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-619-3051
-----------------------------------------------------
Fax | 561-619-3055
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MAURICIO E MELHADO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 561-619-3051
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | ME 89191
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------