Healthcare Provider Details

I. General information

NPI: 1265252407
Provider Name (Legal Business Name): MELBA OVALLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2404 S F ST STE C
HARLINGEN TX
78552-7591
US

IV. Provider business mailing address

2404 S F ST STE C
HARLINGEN TX
78552-7591
US

V. Phone/Fax

Practice location:
  • Phone: 956-622-3009
  • Fax:
Mailing address:
  • Phone: 956-622-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT123615
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: