Provider Demographics
NPI:1154379113
Name:CRUZ-MELENDEZ, JOSE LUIS (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:CRUZ-MELENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 LAS AMERICAS AVE.
Mailing Address - Street 2:EDF. A PORRATA PILA SUITE 301
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2115
Mailing Address - Country:US
Mailing Address - Phone:787-843-3538
Mailing Address - Fax:787-840-5189
Practice Address - Street 1:2431 AVE LAS AMERICAS
Practice Address - Street 2:EDF. A PORRATA PILA SUITE 301
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2113
Practice Address - Country:US
Practice Address - Phone:787-843-3538
Practice Address - Fax:787-840-5189
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7029208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics