Healthcare Provider Details

I. General information

NPI: 1508992355
Provider Name (Legal Business Name): MELANIA YEATS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 W ANIMAS ST
FARMINGTON NM
87401-5616
US

IV. Provider business mailing address

PO BOX 844088
DALLAS TX
75284-4088
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-6300
  • Fax: 505-609-2259
Mailing address:
  • Phone: 505-609-2258
  • Fax: 505-609-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2003-0177
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: