Provider Demographics
NPI:1699056168
Name:MELENDEZ, SARA ALICIA (CCNS)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ALICIA
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:CCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 LANE ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-2617
Mailing Address - Country:US
Mailing Address - Phone:956-229-9928
Mailing Address - Fax:
Practice Address - Street 1:6801 MCPHERSON RD STE 220
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6403
Practice Address - Country:US
Practice Address - Phone:956-722-0422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX690163364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine