Provider Demographics
NPI:1073382537
Name:LUEVANO, MARY MELISSA
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MELISSA
Last Name:LUEVANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49713 GORMAN POST RD
Mailing Address - Street 2:
Mailing Address - City:GORMAN
Mailing Address - State:CA
Mailing Address - Zip Code:93243-9701
Mailing Address - Country:US
Mailing Address - Phone:661-724-0001
Mailing Address - Fax:
Practice Address - Street 1:49713 GORMAN POST RD
Practice Address - Street 2:
Practice Address - City:GORMAN
Practice Address - State:CA
Practice Address - Zip Code:93243-9701
Practice Address - Country:US
Practice Address - Phone:661-724-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator