1265841456 NPI number — MISS MELANIE MARIA RONQUILLO BACHLOR OF ARTS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265841456 NPI number — MISS MELANIE MARIA RONQUILLO BACHLOR OF ARTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RONQUILLO
Provider First Name:
MELANIE
Provider Middle Name:
MARIA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
BACHLOR OF ARTS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265841456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1304 CALLE ROSAMARIA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIMAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91773-4438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-485-0227
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8135 PAINTER AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WHITTIER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90602-3158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-698-6600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2355S0801X , with the licence number:  SPA 2810 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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