Healthcare Provider Details

I. General information

NPI: 1457239709
Provider Name (Legal Business Name): ERIN MELENDREZ CCSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 6TH ST S
SOCORRO NM
87801-4139
US

IV. Provider business mailing address

500 CARMEN PL
SOCORRO NM
87801-4728
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-4140
  • Fax:
Mailing address:
  • Phone: 575-517-9356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: