Provider Demographics
NPI:1366561557
Name:MELENDEZ PAGAN, BEBELIN
Entity type:Individual
Prefix:
First Name:BEBELIN
Middle Name:
Last Name:MELENDEZ PAGAN
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 1:89 AVE DE DIEGO STE 105
Mailing Address - Street 2:PMB 619
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6370
Mailing Address - Country:US
Mailing Address - Phone:787-748-3818
Mailing Address - Fax:787-748-3818
Practice Address - Street 1:300 BLVD RAMALLO
Practice Address - Street 2:CARR # 1 OFF 213
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-9786
Practice Address - Country:US
Practice Address - Phone:787-748-3818
Practice Address - Fax:787-748-3818
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13724207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH90401Medicare UPIN