MEDICARE: MELI BA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1962943985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELI BA INC

Provider Business Mailing Address
First Line	:	11117 W OKEECHOBEE RD STE 104
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4200
Country	:	US
Telephone Number	:	305-333-8182
Fax Number	:

Provider Business Practice Location Address
First Line	:	11117 W OKEECHOBEE RD STE 104
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4200
Country	:	US
Telephone Number	:	305-333-8182
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MARILOLI FERNANDEZ
Credential	:
Telephone Number	:	305-333-8182

Provider Enumeration Date	:	03/09/2017
Last Update Date	:	03/09/2017

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Directions to “MELI BA INC ” Practice Location

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