Healthcare Provider Details

I. General information

NPI: 1033589767
Provider Name (Legal Business Name): MELANIE LAOYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25941 BANCROFT ST
LOMA LINDA CA
92354-3969
US

IV. Provider business mailing address

25941 BANCROFT ST
LOMA LINDA CA
92354-3969
US

V. Phone/Fax

Practice location:
  • Phone: 951-675-2976
  • Fax:
Mailing address:
  • Phone: 951-675-2976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86016020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: