Individual
MELODY J A DESANTIAGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
4102 S CLEAR CREEK RD STE 107, KILLEEN, TX 76549-5954
(254) 526-8300
(254) 526-4828
Mailing address
503 W VARDEMAN AVE, KILLEEN, TX 76541-7962
(254) 501-3793
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
AP113575
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
367312101
—
TX
Enumeration date
07/20/2006
Last updated
07/21/2022
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