Provider Demographics
NPI:1891544813
Name:MELVIN, LA-TOYA MARIE
Entity type:Individual
Prefix:MRS
First Name:LA-TOYA
Middle Name:MARIE
Last Name:MELVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LA-TOYA
Other - Middle Name:M
Other - Last Name:HAMBLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1108 NEW POINTE BLVD STE 130133
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-4252
Mailing Address - Country:US
Mailing Address - Phone:877-528-6926
Mailing Address - Fax:
Practice Address - Street 1:1108 NEW POINTE BLVD STE 130133
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4252
Practice Address - Country:US
Practice Address - Phone:877-528-6926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service