Healthcare Provider Details

I. General information

NPI: 1134305253
Provider Name (Legal Business Name): JOSE ANGEL MELENDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 N. LOOP WEST SUITE 600
HOUSTON TX
77008-1592
US

IV. Provider business mailing address

1631 N. LOOP WEST SUITE 600
HOUSTON TX
77008-1592
US

V. Phone/Fax

Practice location:
  • Phone: 713-863-0902
  • Fax: 713-863-8682
Mailing address:
  • Phone: 713-863-0902
  • Fax: 713-863-7107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberN7311
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: