Provider Demographics
NPI:1083713952
Name:FUENTES, MELECIA (MD)
Entity Type:Individual
Prefix:
First Name:MELECIA
Middle Name:
Last Name:FUENTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6420
Mailing Address - Country:US
Mailing Address - Phone:956-447-8377
Mailing Address - Fax:956-973-8034
Practice Address - Street 1:1206 E 6TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6420
Practice Address - Country:US
Practice Address - Phone:956-447-8377
Practice Address - Fax:956-973-8034
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7156207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0045MBOtherBLUE CROSS BLUE SHIELD
TX163232502Medicaid
TXP00184355OtherRAILROAD MEDICARE
TXP00184355OtherRAILROAD MEDICARE
TX8D0766Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NO.