Provider Demographics
NPI:1508576620
Name:MELENDREZ, OLGA PIERINA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:PIERINA
Last Name:MELENDREZ
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 1:1336 W AGATE WAY
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-2089
Mailing Address - Country:US
Mailing Address - Phone:405-361-9390
Mailing Address - Fax:
Practice Address - Street 1:1336 W AGATE WAY
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-2089
Practice Address - Country:US
Practice Address - Phone:405-361-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator