Provider Demographics
NPI:1497291777
Name:MELENDEZ, BERTHA YESENIA
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:YESENIA
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S ROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-5999
Mailing Address - Country:US
Mailing Address - Phone:775-499-5525
Mailing Address - Fax:
Practice Address - Street 1:1200 S ROCK BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-5999
Practice Address - Country:US
Practice Address - Phone:775-499-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician