1841784766 NPI number — MELISSA HOBAICA DC

Table of content: MELISSA HOBAICA DC (NPI 1841784766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841784766 NPI number — MELISSA HOBAICA DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOBAICA
Provider First Name:
MELISSA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841784766
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2275 N GREEN VALLEY PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89014-5025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-435-0808
Provider Business Mailing Address Fax Number:
702-435-0818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2275 N GREEN VALLEY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89014-5025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-435-0808
Provider Business Practice Location Address Fax Number:
702-435-0818
Provider Enumeration Date:
06/15/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  B01785 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 0104557497 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0104557497 . This is a "STATE LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: B01785 . This is a "STATE LISENCE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".