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NPI Code Detail

MEDICARE: MELISSA PORTELA A.T.

MEDICARE: MELISSA PORTELA A.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174H00000XHealth Educator

General Provider Information

NPI Number : 1053857474
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA PORTELA A.T.
Provider Business Mailing Address
First Line : 25250 N 35TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85083-4335
Country : US
Telephone Number : 623-445-7193
Fax Number :
Provider Business Practice Location Address
First Line : 25250 N 35TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85083-4335
Country : US
Telephone Number : 623-445-7193
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2017
Last Update Date : 01/09/2017

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Directions to “ MELISSA PORTELA A.T.” Practice Location

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