Provider Demographics
NPI:1396844296
Name:MELECIA FUENTES MD PA
Entity Type:Organization
Organization Name:MELECIA FUENTES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-447-8377
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDC6925OtherRAILROAD MEDICARE GROUP
TX170986701Medicaid
TX170986702Medicaid