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General NPI Number Information
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NPI Number | 1578389284
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Entity Type | Organization
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Legal Business Name | MELBA LEE INC
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 1101 WILLOW PINES CT E
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City | TAMPA
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State | FL
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Zip | 33604-6449
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Country | US
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Telephone | 813-542-6000
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Fax | 813-533-6791
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Provider Business Mailing Address
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Address Line | 1101 WILLOW PINES CT E
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City | TAMPA
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State | FL
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Zip | 33604-6449
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Country | US
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Telephone | 813-542-6000
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Fax | 813-533-6791
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | MRS. MELBA ESTELLA RIVERA
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Credential |
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Telephone | 813-770-0312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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