Provider Demographics
NPI:1265119002
Name:MELENDEZ MALDONADO, IREMAR
Entity type:Individual
Prefix:
First Name:IREMAR
Middle Name:
Last Name:MELENDEZ MALDONADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB BELLA VISTA
Mailing Address - Street 2:CALLE GIRASOL F33
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-4105
Mailing Address - Country:US
Mailing Address - Phone:787-513-3961
Mailing Address - Fax:
Practice Address - Street 1:URB BELLA VISTA
Practice Address - Street 2:CALLE GIRASOL F33
Practice Address - City:AIBONITO
Practice Address - State:RI
Practice Address - Zip Code:00705-4105
Practice Address - Country:US
Practice Address - Phone:787-513-3961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6158795390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program