Provider Demographics
NPI:1831770866
Name:MELGAR, BORIS ORLANDO
Entity type:Individual
Prefix:
First Name:BORIS
Middle Name:ORLANDO
Last Name:MELGAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9529 GRAND GROVE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-0105
Mailing Address - Country:US
Mailing Address - Phone:702-502-1566
Mailing Address - Fax:
Practice Address - Street 1:9529 GRAND GROVE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-0105
Practice Address - Country:US
Practice Address - Phone:702-502-1566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA5768329OtherDRIVERS LICENSE