Provider Demographics
NPI:1164280798
Name:MELENDEZ, MARISOL E (OD)
Entity Type:Individual
Prefix:DR
First Name:MARISOL
Middle Name:E
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 CAMBRIDGE ST # 3
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1316
Mailing Address - Country:US
Mailing Address - Phone:617-953-4750
Mailing Address - Fax:
Practice Address - Street 1:1198 CAMBRIDGE ST # 3
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1316
Practice Address - Country:US
Practice Address - Phone:617-953-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program