Healthcare Provider Details

I. General information

NPI: 1720835390
Provider Name (Legal Business Name): DANIELA MELLO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 05/02/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21902 FRANKLIN PARK APT 1308
SAN ANTONIO TX
78259-2193
US

IV. Provider business mailing address

4002 MOUNT LAUREL DR
SAN ANTONIO TX
78240-1024
US

V. Phone/Fax

Practice location:
  • Phone: 210-491-1690
  • Fax: 210-491-1801
Mailing address:
  • Phone: 210-287-6889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1003172
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number174203
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: