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General NPI Number Information
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NPI Number | 1962943985
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Entity Type | Organization
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Legal Business Name | MELI BA INC
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 11117 W OKEECHOBEE RD STE 104
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City | HIALEAH GARDENS
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State | FL
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Zip | 33018-4200
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Country | US
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Telephone | 305-333-8182
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Fax |
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Provider Business Mailing Address
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Address Line | 11117 W OKEECHOBEE RD STE 104
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City | HIALEAH GARDENS
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State | FL
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Zip | 33018-4200
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Country | US
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Telephone | 305-333-8182
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MARILOLI FERNANDEZ
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Credential |
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Telephone | 305-333-8182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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