Provider Demographics
NPI:1093281776
Name:MARCHA, MELCHOR NACIONAL
Entity Type:Individual
Prefix:
First Name:MELCHOR
Middle Name:NACIONAL
Last Name:MARCHA
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 1:3998 VISTA WAY STE E
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4514
Mailing Address - Country:US
Mailing Address - Phone:760-295-9830
Mailing Address - Fax:760-295-9866
Practice Address - Street 1:3998 VISTA WAY STE E
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4514
Practice Address - Country:US
Practice Address - Phone:760-295-9830
Practice Address - Fax:760-295-9866
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY2987826172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY2987826OtherDRIVER LICENSE