=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396844296
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MELECIA FUENTES MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 07/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1206 E 6TH ST
-----------------------------------------------------
City | WESLACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78596-6420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-447-8377
-----------------------------------------------------
Fax | 956-973-8034
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1206 E 6TH ST
-----------------------------------------------------
City | WESLACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78596-6420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-447-8377
-----------------------------------------------------
Fax | 956-973-8034
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MELECIA FUENTES
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 956-447-8377
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------