Provider Demographics
NPI:1710547401
Name:MELICIOUS LLC
Entity type:Organization
Organization Name:MELICIOUS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN
Authorized Official - Phone:480-658-0028
Mailing Address - Street 1:3555 S VAL VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7323
Mailing Address - Country:US
Mailing Address - Phone:480-658-0028
Mailing Address - Fax:602-429-8340
Practice Address - Street 1:313 N GILBERT RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5995
Practice Address - Country:US
Practice Address - Phone:480-658-0028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-16
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty