Provider Demographics
NPI:1437926284
Name:FULGENCIO, MELISSA KAYE (PARAMEDICAL ARTIST)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:KAYE
Last Name:FULGENCIO
Suffix:
Gender:F
Credentials:PARAMEDICAL ARTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 HARWOOD RD STE 3
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-4189
Mailing Address - Country:US
Mailing Address - Phone:844-407-3733
Mailing Address - Fax:
Practice Address - Street 1:240 HARWOOD RD STE 3
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-4189
Practice Address - Country:US
Practice Address - Phone:844-407-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1003787174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist