MEDICARE: DR. TERESITA LU MELOCOTON M.D.

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
1	208000000X	Pediatrics Physician	9127	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831288877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESITA LU MELOCOTON M.D.

Provider Business Mailing Address
First Line	:	3100 W CHARLESTON BLVD
Second Line	:	SUITE 210
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2023
Country	:	US
Telephone Number	:	702-388-4428
Fax Number	:	702-388-4312

Provider Business Practice Location Address
First Line	:	3701 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1844
Country	:	US
Telephone Number	:	702-388-4428
Fax Number	:	702-388-4312

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	04/19/2023

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