Healthcare Provider Details

I. General information

NPI: 1790365468
Provider Name (Legal Business Name): MELINA J THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S CANON DR APT 4
BEVERLY HILLS CA
90212-3123
US

IV. Provider business mailing address

120 S CANON DR APT 4
BEVERLY HILLS CA
90212-3123
US

V. Phone/Fax

Practice location:
  • Phone: 850-232-5535
  • Fax:
Mailing address:
  • Phone: 850-232-5535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-68256
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number20-121004
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: