Provider Demographics
NPI:1689126963
Name:MELENDRES, JOSE ROBERTO (RN)
Entity Type:Individual
Prefix:MR
First Name:JOSE ROBERTO
Middle Name:
Last Name:MELENDRES
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10196 COUNTRYSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2463
Mailing Address - Country:US
Mailing Address - Phone:916-476-1688
Mailing Address - Fax:916-266-9423
Practice Address - Street 1:10196 COUNTRYSIDE WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2463
Practice Address - Country:US
Practice Address - Phone:916-476-1688
Practice Address - Fax:916-266-9423
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN763451163WC0400X
CA10221411163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WW0000XNursing Service ProvidersRegistered NurseWound Care