MEDICARE: LUIS MELENDEZ CFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	97966	FL

General Provider Information

NPI Number	:	1023157203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS MELENDEZ CFA

Provider Business Mailing Address
First Line	:	1401 RIVERPLACE BLVD
Second Line	:	SUITE# 610
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-9069
Country	:	US
Telephone Number	:	904-962-8932
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 RIVERPLACE BLVD
Second Line	:	# 610
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-9069
Country	:	US
Telephone Number	:	904-962-8932
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	01/21/2009

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Directions to “ LUIS MELENDEZ CFA” Practice Location

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