Basic Information
| Provider Information | |||||||||
| NPI: | 1841467263 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALBA | ||||||||
| FirstName: | MELINDA | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13640 N PLAZA DEL RIO BLVD | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853814846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238766922 | ||||||||
| FaxNumber: | 6239729590 | ||||||||
| Practice Location | |||||||||
| Address1: | 13640 N PLAZA DEL RIO BLVD | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853814846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238766922 | ||||||||
| FaxNumber: | 6239729590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2008 | ||||||||
| LastUpdateDate: | 10/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 59854 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 63551-20 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 23698 | MS | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 13584 | ND | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD-40656 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 40726 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | Q3322 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | C140869 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 74853 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 9114006-1205 | UT | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 04-37528 | KS | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2014030682 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD.33713 | AL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 9338 | SD | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 036.120402 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 354354 | 05 | AZ | MEDICAID |