Provider Demographics
NPI:1417462003
Name:MELENDEZ, MARISOL M (RDCS, RVT)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:M
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:RDCS, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-6765
Mailing Address - Country:US
Mailing Address - Phone:732-771-7888
Mailing Address - Fax:
Practice Address - Street 1:902 WILLOW DR
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6765
Practice Address - Country:US
Practice Address - Phone:732-771-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC142552246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC142552OtherARDMS