Provider Demographics
NPI:1174277271
Name:MELINDA BENZ LLC
Entity Type:Organization
Organization Name:MELINDA BENZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENZ
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:720-340-8048
Mailing Address - Street 1:1751 HOVER ST
Mailing Address - Street 2:STE B4 #84
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501
Mailing Address - Country:US
Mailing Address - Phone:719-347-1310
Mailing Address - Fax:
Practice Address - Street 1:1751 HOVER ST
Practice Address - Street 2:STE B4 #84
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501
Practice Address - Country:US
Practice Address - Phone:719-347-1310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty