Provider Demographics
NPI:1861928970
Name:FERNANDEZ, MELISSA ELENA
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ELENA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:ELENA
Other - Last Name:IBANEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2717 HOWELL ST
Mailing Address - Street 2:APARTMENT 1202
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1104
Mailing Address - Country:US
Mailing Address - Phone:305-498-2268
Mailing Address - Fax:
Practice Address - Street 1:2717 HOWELL ST
Practice Address - Street 2:APARTMENT 1202
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-1104
Practice Address - Country:US
Practice Address - Phone:305-498-2268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician