MEDICARE: DR. MELISSA IGLESIAS D.O.

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	207WX0107X	Retina Specialist (Ophthalmology) Physician	OS12688	FL
2	207W00000X	Ophthalmology Physician	OS12688	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225112634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA IGLESIAS D.O.

Provider Business Mailing Address
First Line	:	11641 KEW GARDENS AVE STE 209
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-2846
Country	:	US
Telephone Number	:	561-331-3833
Fax Number	:

Provider Business Practice Location Address
First Line	:	11641 KEW GARDENS AVE STE 209
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-2846
Country	:	US
Telephone Number	:	561-331-3833
Fax Number	:	561-331-3893

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	01/14/2022

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Directions to “ DR. MELISSA IGLESIAS D.O.” Practice Location

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