Provider Demographics
NPI:1477251395
Name:TOHLAKAI, MELISSA (NUTRITIONIST, HERBAL)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:TOHLAKAI
Suffix:
Gender:F
Credentials:NUTRITIONIST, HERBAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12688 MESA VIEW ROAD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS
Mailing Address - State:AZ
Mailing Address - Zip Code:86046
Mailing Address - Country:US
Mailing Address - Phone:602-632-9435
Mailing Address - Fax:
Practice Address - Street 1:145 W ROUTE 66
Practice Address - Street 2:SUITE D
Practice Address - City:WILLIAMS
Practice Address - State:AZ
Practice Address - Zip Code:86046
Practice Address - Country:US
Practice Address - Phone:602-632-9435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No171400000XOther Service ProvidersHealth & Wellness Coach