Provider Demographics
NPI:1730265877
Name:MELENDEZ, MARTA J (2705)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:J
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:2705
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BUZON 35 BO. SAN ANTON
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717
Mailing Address - Country:US
Mailing Address - Phone:787-840-8903
Mailing Address - Fax:787-840-8903
Practice Address - Street 1:BUZON 35 BO. SAN ANTON
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-840-8903
Practice Address - Fax:787-840-8903
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2705183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician