Provider Demographics
NPI:1649409715
Name:CAPPA-MELENDEZ, ALFONSO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:
Last Name:CAPPA-MELENDEZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 EAGLERIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2103
Mailing Address - Country:US
Mailing Address - Phone:719-470-0514
Mailing Address - Fax:719-960-2444
Practice Address - Street 1:1124 EAGLERIDGE BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2103
Practice Address - Country:US
Practice Address - Phone:719-470-0514
Practice Address - Fax:719-960-2444
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004337103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO731420Medicaid