Provider Demographics
NPI:1225543275
Name:MELENDREZ, RACHEL NAOMI (ABOC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:NAOMI
Last Name:MELENDREZ
Suffix:
Gender:F
Credentials:ABOC
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 322
Mailing Address - Street 2:
Mailing Address - City:OCCOQUAN
Mailing Address - State:VA
Mailing Address - Zip Code:22125-0322
Mailing Address - Country:US
Mailing Address - Phone:703-310-6644
Mailing Address - Fax:
Practice Address - Street 1:125 MILL ST STE 12
Practice Address - Street 2:
Practice Address - City:OCCOQUAN
Practice Address - State:VA
Practice Address - Zip Code:22125-7732
Practice Address - Country:US
Practice Address - Phone:703-310-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA192508156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician