Provider Demographics
NPI:1760912240
Name:MELENDEZ, MARVIN DE VERA JR (MSN; NP-C)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:DE VERA
Last Name:MELENDEZ
Suffix:JR
Gender:M
Credentials:MSN; NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-5930
Mailing Address - Country:US
Mailing Address - Phone:562-253-5436
Mailing Address - Fax:
Practice Address - Street 1:2031 RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-5930
Practice Address - Country:US
Practice Address - Phone:562-253-5436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily