Provider Demographics
NPI:1245326115
Name:MELENDEZ, VENA P (PA-C)
Entity type:Individual
Prefix:MRS
First Name:VENA
Middle Name:P
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:15906 MILL CREEK BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1797
Mailing Address - Country:US
Mailing Address - Phone:425-385-2009
Mailing Address - Fax:425-939-0807
Practice Address - Street 1:15906 MILL CREEK BLVD STE 105
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1797
Practice Address - Country:US
Practice Address - Phone:425-385-2009
Practice Address - Fax:425-939-0807
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA15783363A00000X
WAPA60066499363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant