Provider Demographics
NPI:1083616007
Name:MELENDEZ, CARLOS ANIBAL (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ANIBAL
Last Name:MELENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5624
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77508-5624
Mailing Address - Country:US
Mailing Address - Phone:713-477-8888
Mailing Address - Fax:713-477-8885
Practice Address - Street 1:908 E SOUTHMORE AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-1134
Practice Address - Country:US
Practice Address - Phone:713-477-8888
Practice Address - Fax:713-477-8885
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7090208000000X
FLME 74872208000000X
PAMD-052944-L208000000X
PR011583208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123913904Medicaid
PAMD-052944-LOtherPA MEDICAL LICENCE
FLME 74872OtherFL MEDICAL LICENCE
TX123913905Medicaid
PR011583OtherPR MEDICAL LICENCE
FLME 74872OtherFL MEDICAL LICENCE