Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MT.0016758 | CO |
NPI | 1053791525 |
---|---|
Provider Name | Ms. Melissa Madueno |
First Address | Peyton, CO 80831-9369 |
Second Address | Peyton, CO 80831-9369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2015 |
Last Update Date | 31/05/2015 |