Provider Demographics
NPI:1124403803
Name:DELL, JOSE MELECIO SR
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:MELECIO
Last Name:DELL
Suffix:SR
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 1:14401 NE 153RD AVE
Mailing Address - Street 2:APARTMENT 21
Mailing Address - City:WALDO
Mailing Address - State:FL
Mailing Address - Zip Code:32694-4020
Mailing Address - Country:US
Mailing Address - Phone:352-260-7372
Mailing Address - Fax:
Practice Address - Street 1:14401 NE 153RD AVE
Practice Address - Street 2:APARTMENT 21
Practice Address - City:WALDO
Practice Address - State:FL
Practice Address - Zip Code:32694-4020
Practice Address - Country:US
Practice Address - Phone:352-260-7372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP5171635164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse