Gail Denise Melpolder, COMS, CLVT, CRC
Individual provider Active NPI Specialist · La Luz, NM
NPI 1598097123 · NPPES record last updated Feb 7, 2010
Key facts
- NPI
- 1598097123
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 4815 - ACVREP
- Practice address
- 6 Fawn LN
La Luz, NM 88337-9339 - Phone
- (575) 415-2008
- Fax
- (888) 453-1138
- NPI assigned
- Feb 7, 2010
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 4815 - ACVREP | Yes | |
| Specialist | 174400000X | 5622 ACVREP | ||
| Specialist | 174400000X | 00016215 CRCC |
Addresses
Primary practice location
6 Fawn LN
La Luz, NM 88337-9339
Mailing address
6 Fawn LN
La Luz, NM 88337-9339
Phone (575) 415-2008
Other providers in La Luz, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 7, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.