Provider Demographics
NPI:1972515856
Name:GRASSETTE MELENDEZ, WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:GRASSETTE 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 1:229 CALLE DEL PARQUE
Mailing Address - Street 2:COND. PARQUE CENTRAL APT. 904
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3223
Mailing Address - Country:US
Mailing Address - Phone:787-795-2935
Mailing Address - Fax:
Practice Address - Street 1:3474 PASEO CAMARON
Practice Address - Street 2:3RA SECCION LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3634
Practice Address - Country:US
Practice Address - Phone:787-795-2521
Practice Address - Fax:787-795-2289
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10816208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0089492Medicare ID - Type UnspecifiedMEDICARE PR
PRG02794Medicare UPIN