Healthcare Provider Details

I. General information

NPI: 1124914403
Provider Name (Legal Business Name): DANIEL DAVID MELENDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2025
Last Update Date: 06/14/2025
Certification Date: 06/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 RIO RANCHO BLVD SE
RIO RANCHO NM
87124-6603
US

IV. Provider business mailing address

2221 RIO RANCHO BLVD SE
RIO RANCHO NM
87124-6603
US

V. Phone/Fax

Practice location:
  • Phone: 404-952-0801
  • Fax:
Mailing address:
  • Phone: 404-952-0801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: