Organization
STA MARIA PEDIATRIC CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESITA LU MELOCOTON MD (MANAGER)
(702) 388-4428
Entity
Organization
Contact information
Practice address
730 N EASTERN AVE, STE 100, LAS VEGAS, NV 89101-2885
(702) 388-4428
(702) 388-4312
Mailing address
3100 W CHARLESTON BLVD, STE 210, LAS VEGAS, NV 89102-1900
(702) 388-4428
(702) 388-4312
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
03/29/2014
Last updated
04/08/2014
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