Healthcare Provider Details

I. General information

NPI: 1508785767
Provider Name (Legal Business Name): RAQUEL MELARA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 C AVE BLDG H
HONOLULU HI
96818-4079
US

IV. Provider business mailing address

3809 BOMAR RD
DOUGLASVILLE GA
30135-2708
US

V. Phone/Fax

Practice location:
  • Phone: 470-927-8023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number25-431615
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: