1154351435 NPI number — DR. ELLIOT MELECIO SR. M.D.

Table of content: DR. ELLIOT MELECIO SR. M.D. (NPI 1154351435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154351435 NPI number — DR. ELLIOT MELECIO SR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MELECIO
Provider First Name:
ELLIOT
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154351435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1775
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VEGA ALTA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00692-1775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-270-0710
Provider Business Mailing Address Fax Number:
787-270-4878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIF. CARIBE MEDICAL PLAZA MARGINAL SANTA RITA 1
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
VEGA ALTA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-270-0710
Provider Business Practice Location Address Fax Number:
787-270-4878
Provider Enumeration Date:
07/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  11777 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)