Provider Demographics
NPI:1649468794
Name:GONZALEZ MELENDEZ, ADALICE
Entity type:Individual
Prefix:
First Name:ADALICE
Middle Name:
Last Name:GONZALEZ MELENDEZ
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 1:5150 MAE ANNE AVE
Mailing Address - Street 2:SUITE 405 PMB 1018
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523
Mailing Address - Country:US
Mailing Address - Phone:787-203-7900
Mailing Address - Fax:
Practice Address - Street 1:300 E 2ND ST STE 1510
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-1591
Practice Address - Country:US
Practice Address - Phone:702-246-2584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1047235Z00000X
235Z00000X
TX116741235Z00000X
CA30176235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist