Provider Demographics
NPI:1265547970
Name:MELENDEZ, ALICIA LOZANO (LVN)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:LOZANO
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BLOOMFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-7609
Mailing Address - Country:US
Mailing Address - Phone:916-983-1279
Mailing Address - Fax:
Practice Address - Street 1:7805 AUBURN BLVD
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-2115
Practice Address - Country:US
Practice Address - Phone:916-969-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN81105164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse