=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457239709
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN MELENDREZ CCSS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2025
-----------------------------------------------------
Last Update Date | 08/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 6TH ST S
-----------------------------------------------------
City | SOCORRO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87801-4139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-865-4140
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 CARMEN PL
-----------------------------------------------------
City | SOCORRO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87801-4728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-517-9356
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------