Healthcare Provider Details

I. General information

NPI: 1023678281
Provider Name (Legal Business Name): MELANIE DOMENECH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 06/07/2022
Certification Date: 05/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DR HITZELBERGER STRABE
LANDSTUHL GERMANY
66849
DE

IV. Provider business mailing address

CMR 402 BOX 2204
APO AE
09180-0023
US

V. Phone/Fax

Practice location:
  • Phone: 850-368-5914
  • Fax:
Mailing address:
  • Phone: 850-368-5914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: