Provider Demographics
NPI:1144892597
Name:MELENDEZ, MARLENE MARYJANE
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:MARYJANE
Last Name: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 1:11240 PANGBORN AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5526
Mailing Address - Country:US
Mailing Address - Phone:562-391-5723
Mailing Address - Fax:
Practice Address - Street 1:11240 PANGBORN AVE APT 16
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5526
Practice Address - Country:US
Practice Address - Phone:562-391-5723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician