Healthcare Provider Details

I. General information

NPI: 1497046536
Provider Name (Legal Business Name): MELISSA JACLYN CLINE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2011
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 MONTGOMERY BLVD NE PRESBYTERIAN HEALTHCARE SERVICES
ALBUQUERQUE NM
87111-2310
US

IV. Provider business mailing address

8800 MONTGOMERY BLVD NE PRESBYTERIAN HEALTHCARE SERVICES
ALBUQUERQUE NM
87111-2310
US

V. Phone/Fax

Practice location:
  • Phone: 505-462-6400
  • Fax: 505-462-6535
Mailing address:
  • Phone: 505-462-6400
  • Fax: 505-462-6535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2014-0197
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: