Healthcare Provider Details

I. General information

NPI: 1912421801
Provider Name (Legal Business Name): LOURDES E MELENDEZ PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 E HUNT HWY STE 10
SAN TAN VALLEY AZ
85143-4963
US

IV. Provider business mailing address

10757 N 74TH ST UNIT 1006
SCOTTSDALE AZ
85260-6470
US

V. Phone/Fax

Practice location:
  • Phone: 480-987-5500
  • Fax:
Mailing address:
  • Phone: 623-210-5892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: LOURDES E MELENDEZ-OETINGER
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 480-987-5500