Provider Demographics
NPI:1013434075
Name:HURNDON, MELVIN LORANCE
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:LORANCE
Last Name:HURNDON
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 1:14050 CHERRY AVE # R58
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-0766
Mailing Address - Country:US
Mailing Address - Phone:909-827-4754
Mailing Address - Fax:
Practice Address - Street 1:14050 CHERRY AVE # R58
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-0766
Practice Address - Country:US
Practice Address - Phone:909-827-4754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)