Healthcare Provider Details

I. General information

NPI: 1851457725
Provider Name (Legal Business Name): MICHELLE LYNN MELENDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 W. COLE BLVD
CALEXICO CA
92231
US

IV. Provider business mailing address

233 W. COLE BOULEVARD
CALEXICO CA
92231
US

V. Phone/Fax

Practice location:
  • Phone: 760-357-2020
  • Fax: 760-357-1056
Mailing address:
  • Phone: 760-357-2020
  • Fax: 760-357-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA92583
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2004-0635
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: