Provider Demographics
NPI:1922681022
Name:CARRASCO, MELISA (CCM)
Entity Type:Individual
Prefix:
First Name:MELISA
Middle Name:
Last Name:CARRASCO
Suffix:
Gender:F
Credentials:CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9102 SPIGEL WAY
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-0210
Mailing Address - Country:US
Mailing Address - Phone:210-808-6524
Mailing Address - Fax:210-539-2084
Practice Address - Street 1:3100 SCHOFIELD RD BLDG 1179
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-7577
Practice Address - Country:US
Practice Address - Phone:210-808-6524
Practice Address - Fax:210-539-2075
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX504829163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management