1659775641 NPI number — MELODY K RATTANAPOTE-MALANEY DPT

Table of content: MELODY K RATTANAPOTE-MALANEY DPT (NPI 1659775641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659775641 NPI number — MELODY K RATTANAPOTE-MALANEY DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RATTANAPOTE-MALANEY
Provider First Name:
MELODY
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RATTANAPOTE
Provider Other First Name:
MELODY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659775641
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 516626
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90051-0600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-836-4899
Provider Business Mailing Address Fax Number:
505-214-5030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 MAIN ST.
Provider Second Line Business Practice Location Address:
STE 1-2
Provider Business Practice Location Address City Name:
SOCORRO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87801-3914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
58-364-8995
Provider Business Practice Location Address Fax Number:
505-214-5030
Provider Enumeration Date:
10/20/2014

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: 225100000X , with the licence number:  4590 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com