Healthcare Provider Details

I. General information

NPI: 1972249480
Provider Name (Legal Business Name): MELINDA MOON RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2022
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 CORPORATE BLVD
RENO NV
89502-7177
US

IV. Provider business mailing address

3425 MARTINI RD
SPARKS NV
89434-9419
US

V. Phone/Fax

Practice location:
  • Phone: 775-788-6880
  • Fax:
Mailing address:
  • Phone: 530-559-3852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: