Healthcare Provider Details

I. General information

NPI: 1255761144
Provider Name (Legal Business Name): MELINDA OLIVAREZ GUTIERREZ RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

662 KATHERINE CT
EL PASO TX
79932-3158
US

IV. Provider business mailing address

1712 GREEN MOUNTAIN TPKE
CHESTER VT
05143-8321
US

V. Phone/Fax

Practice location:
  • Phone: 915-373-8361
  • Fax:
Mailing address:
  • Phone: 888-818-5653
  • Fax: 802-875-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-14410
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number666901
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: