Provider Demographics
NPI:1316929201
Name:MELENDEZ-OETINGER, LOURDES E (MD)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:E
Last Name:MELENDEZ-OETINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LOURDES
Other - Middle Name:E
Other - Last Name:MELENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10757 N 74TH STREET
Mailing Address - Street 2:UNIT 1006
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-283-9664
Mailing Address - Fax:
Practice Address - Street 1:270 E HUNT HWY STE 10
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-4963
Practice Address - Country:US
Practice Address - Phone:480-987-5500
Practice Address - Fax:480-987-5017
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25813207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ408569Medicaid
G63491Medicare UPIN
G63491Medicare UPIN