Healthcare Provider Details

I. General information

NPI: 1083616007
Provider Name (Legal Business Name): CARLOS ANIBAL MELENDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 E SOUTHMORE AVE SUITE 290
PASADENA TX
77502-1134
US

IV. Provider business mailing address

PO BOX 5624
PASADENA TX
77508-5624
US

V. Phone/Fax

Practice location:
  • Phone: 713-477-8888
  • Fax: 713-477-8885
Mailing address:
  • Phone: 713-477-8888
  • Fax: 713-477-8885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ7090
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 74872
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-052944-L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number011583
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: