Provider Demographics
NPI:1497014435
Name:MELENCIO RAON LINGA
Entity Type:Organization
Organization Name:MELENCIO RAON LINGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MELENCIO
Authorized Official - Middle Name:RAON
Authorized Official - Last Name:LINGA
Authorized Official - Suffix:JR
Authorized Official - Credentials:BHRS
Authorized Official - Phone:405-641-0080
Mailing Address - Street 1:5609 NE 107TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73151-9548
Mailing Address - Country:US
Mailing Address - Phone:405-771-8736
Mailing Address - Fax:
Practice Address - Street 1:5609 NE 107TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73151-9548
Practice Address - Country:US
Practice Address - Phone:405-771-8736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health