Provider Demographics
NPI:1265904643
Name:MELENDEZ, ELOISA LIZETT
Entity type:Individual
Prefix:
First Name:ELOISA
Middle Name:LIZETT
Last Name:MELENDEZ
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 1:8131 LEMON AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-6451
Mailing Address - Country:US
Mailing Address - Phone:760-990-3462
Mailing Address - Fax:
Practice Address - Street 1:8131 LEMON AVE APT 3
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-6451
Practice Address - Country:US
Practice Address - Phone:760-990-3462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-22
Last Update Date:2018-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95182745163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse