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General NPI Number Information
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NPI Number | 1841542719
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Entity Type | Individual
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Provider Name | JACQUELINE Y MELENDEZ OD
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Gender | Female
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 05/03/2024
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Provider Practice Location Address
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Address Line | 4246 STREET #2 KM 43.0
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City | VEGA BAJA
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State | PR
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Zip | 00693-0069
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Country | US
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Telephone | 787-369-6591
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Fax | 873-690-7117
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Provider Business Mailing Address
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Address Line | 4246 CARR 2
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City | VEGA BAJA
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State | PR
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Zip | 00693-4128
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Country | US
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Telephone | 787-369-6591
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Fax | 787-369-0711
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00639900
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License Number State | NJ
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