Provider Demographics
NPI:1306346846
Name:MELGOZA, RITA AMARISA
Entity type:Individual
Prefix:PROF
First Name:RITA
Middle Name:AMARISA
Last Name:MELGOZA
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:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-0906
Mailing Address - Country:US
Mailing Address - Phone:903-431-9751
Mailing Address - Fax:
Practice Address - Street 1:2019 TOLER RD APT 301
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2223
Practice Address - Country:US
Practice Address - Phone:903-431-9751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX146456164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse