Provider Demographics
NPI:1184499337
Name:MELENDEZ, CARLA (PA)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24654 N LAKE PLEASANT PKWY
Mailing Address - Street 2:STE 103 MAILBOX 818
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383
Mailing Address - Country:US
Mailing Address - Phone:602-598-1616
Mailing Address - Fax:
Practice Address - Street 1:140 N LITCHFIELD RD STE 110
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1226
Practice Address - Country:US
Practice Address - Phone:602-456-1835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10043363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant