Provider Demographics
NPI:1821723545
Name:IDI, MELINA LAUREANNE
Entity Type:Individual
Prefix:
First Name:MELINA
Middle Name:LAUREANNE
Last Name:IDI
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:SABITI
Other - Middle Name:MUKANKWA
Other - Last Name:SEFU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8519 VISTA WOODS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77028-1467
Mailing Address - Country:US
Mailing Address - Phone:832-267-1488
Mailing Address - Fax:
Practice Address - Street 1:8519 VISTA WOODS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77028-1467
Practice Address - Country:US
Practice Address - Phone:832-267-1488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver