Provider Demographics
NPI:1568892545
Name:VALLEY PEDIATRIC & SPECIALTY CENTER
Entity Type:Organization
Organization Name:VALLEY PEDIATRIC & SPECIALTY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:LU
Authorized Official - Last Name:MELOCOTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-388-4428
Mailing Address - Street 1:3100 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2023
Mailing Address - Country:US
Mailing Address - Phone:702-388-4428
Mailing Address - Fax:702-388-4312
Practice Address - Street 1:3100 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2023
Practice Address - Country:US
Practice Address - Phone:702-388-4428
Practice Address - Fax:702-388-4312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9127174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty