Provider Demographics
NPI:1528845799
Name:MELENDEZ, JOSE JOSHUA
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:JOSHUA
Last Name:MELENDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1073
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-1073
Mailing Address - Country:US
Mailing Address - Phone:407-607-1321
Mailing Address - Fax:
Practice Address - Street 1:14450 DESERT HAVEN ST
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6816
Practice Address - Country:US
Practice Address - Phone:407-607-1321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No305S00000XManaged Care OrganizationsPoint of Service