Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 192508 | VA |
NPI | 1225543275 |
---|---|
Provider Name | Rachel Naomi Melendrez |
First Address | Occoquan, VA 22125-0322 |
Second Address | Occoquan, VA 22125-7732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2017 |
Last Update Date | 12/12/2017 |