Individual
FANNY PAOLA MELENDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2255 RENAISSANCE DR STE A, LAS VEGAS, NV 89119-6194
(702) 451-7542
Mailing address
2255 RENAISSANCE DR STE A, LAS VEGAS, NV 89119-6194
(702) 451-7542
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4548926
MEXICAN PROFESSIONAL LICENSE
—
01
—
A27-11-07
CLINICAL PSYCHO PEDAGOGY MASTER CERTIFICATE
—
Enumeration date
10/29/2018
Last updated
06/11/2019
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