Provider Demographics
NPI:1992712673
Name:MELENDEZ HERNANDEZ, JONATHAN A (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:A
Last Name:MELENDEZ HERNANDEZ
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:URB. TINTILLO GDNS
Mailing Address - Street 2:H23 CALLE 6
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-1672
Mailing Address - Country:US
Mailing Address - Phone:787-783-0135
Mailing Address - Fax:
Practice Address - Street 1:URB. TINTILLO GDNS
Practice Address - Street 2:H23 CALLE 6
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-1672
Practice Address - Country:US
Practice Address - Phone:787-783-0135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13231207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI50927Medicare UPIN