Provider Demographics
NPI:1396907499
Name:MELENDEZ-LECCA, DANTE PAOLO (MD)
Entity type:Individual
Prefix:
First Name:DANTE
Middle Name:PAOLO
Last Name:MELENDEZ-LECCA
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 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:601 N FLAMINGO RD STE 302
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1010
Practice Address - Country:US
Practice Address - Phone:954-276-1616
Practice Address - Fax:954-276-0186
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME165000207RI0200X
MN105513207RI0200X
MN54519207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120588800Medicaid
MN440000311Medicare PIN