Provider Demographics
NPI:1801151543
Name:FUERTES-MELENDEZ, KENIA MIGUELINA (MSE)
Entity type:Individual
Prefix:MS
First Name:KENIA
Middle Name:MIGUELINA
Last Name:FUERTES-MELENDEZ
Suffix:
Gender:F
Credentials:MSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2058 CRUGER AVE
Mailing Address - Street 2:APT# A4
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2902
Mailing Address - Country:US
Mailing Address - Phone:646-942-4485
Mailing Address - Fax:
Practice Address - Street 1:2510 WESTCHESTER AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3512
Practice Address - Country:US
Practice Address - Phone:718-597-5558
Practice Address - Fax:718-597-7277
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist