Provider Demographics
NPI:1407123201
Name:MELENDEZ, ESTEBAN (MS, ATC/AT, LMT)
Entity Type:Individual
Prefix:MR
First Name:ESTEBAN
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:M
Credentials:MS, ATC/AT, LMT
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 5770
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85211-5770
Mailing Address - Country:US
Mailing Address - Phone:800-544-5690
Mailing Address - Fax:480-668-4546
Practice Address - Street 1:160 EAST 6TH PLACE
Practice Address - Street 2:FITCH PARK
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201
Practice Address - Country:US
Practice Address - Phone:800-544-5690
Practice Address - Fax:480-668-4546
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ06822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer