Provider Demographics
NPI:1144826371
Name:MELENDEZ, LAURA (MFC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7372 PORTAGE WAY
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-4670
Mailing Address - Country:US
Mailing Address - Phone:760-310-9815
Mailing Address - Fax:760-476-9617
Practice Address - Street 1:1902 WRIGHT PL
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-6583
Practice Address - Country:US
Practice Address - Phone:760-310-9815
Practice Address - Fax:760-476-9617
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37545106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist