Basic Information
| Provider Information | |||||||||
| NPI: | 1801151543 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FUERTES-MELENDEZ | ||||||||
| FirstName: | KENIA | ||||||||
| MiddleName: | MIGUELINA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2058 CRUGER AVE | ||||||||
| Address2: | APT# A4 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104622902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6469424485 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2510 WESTCHESTER AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104613512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185975558 | ||||||||
| FaxNumber: | 7185977277 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2012 | ||||||||
| LastUpdateDate: | 07/09/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | Other Service Providers | Specialist |
No ID Information.