Provider Demographics
NPI:1629659560
Name:MENJIVAR, MELANY JOANNA
Entity Type:Individual
Prefix:
First Name:MELANY
Middle Name:JOANNA
Last Name:MENJIVAR
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 1:3007 CURTIS DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-3678
Mailing Address - Country:US
Mailing Address - Phone:832-681-0393
Mailing Address - Fax:
Practice Address - Street 1:3007 CURTIS DR
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-3678
Practice Address - Country:US
Practice Address - Phone:832-681-0393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer