Provider Demographics
NPI:1215607460
Name:GLORIA, MELANIE FAITH
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:FAITH
Last Name:GLORIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 SW 37TH AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-4131
Mailing Address - Country:US
Mailing Address - Phone:786-301-2867
Mailing Address - Fax:
Practice Address - Street 1:669 SW 37TH AVE APT 104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-4131
Practice Address - Country:US
Practice Address - Phone:786-301-2867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-19
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer