Healthcare Provider Details

I. General information

NPI: 1124944830
Provider Name (Legal Business Name): MELINDA MIDORI LEIVA CRDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MUNRO AVE
CAPE MAY NJ
08204-5000
US

IV. Provider business mailing address

1460 DELAWARE AVE APT D
CAPE MAY NJ
08204-4040
US

V. Phone/Fax

Practice location:
  • Phone: 910-409-3814
  • Fax:
Mailing address:
  • Phone: 910-409-3814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH36305
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: