Provider Demographics
NPI:1831288877
Name:MELOCOTON, TERESITA LU (MD)
Entity type:Individual
Prefix:DR
First Name:TERESITA
Middle Name:LU
Last Name:MELOCOTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TERESITA
Other - Middle Name:RAZ
Other - Last Name:LU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
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 1:3701 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1844
Practice Address - Country:US
Practice Address - Phone:702-388-4428
Practice Address - Fax:702-388-4312
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9127208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018826Medicaid
F57076Medicare UPIN