Healthcare Provider Details

I. General information

NPI: 1447926142
Provider Name (Legal Business Name): MAYRA MELENDEZ APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2021
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N MESA ST STE 200
EL PASO TX
79902-3554
US

IV. Provider business mailing address

1800 N MESA ST STE 200
EL PASO TX
79902-3554
US

V. Phone/Fax

Practice location:
  • Phone: 915-577-9900
  • Fax:
Mailing address:
  • Phone: 915-577-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP145504
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: