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General NPI Number Information
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NPI Number | 1063038602
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Entity Type | Individual
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Provider Name | MELISA PORTELA DE LA LUZ
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Gender | Female
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Dates
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Enumeration Date | 06/19/2020
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Last Update Date | 06/19/2020
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Provider Practice Location Address
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Address Line | 4 CALLE HERADIO MENDOZA ESTE
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City | CAYEY
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State | PR
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Zip | 00736
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Country | US
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Telephone | 787-535-1001
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Fax |
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Provider Business Mailing Address
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Address Line | 288 CALLE ALFREDO GALVEZ
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City | SAN JUAN
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State | PR
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Zip | 00926-5838
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Country | US
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Telephone | 787-600-4586
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | PR
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