Provider Demographics
NPI:1356103469
Name:MELENDREZ, MARC LEE MACALALAG (FNP-C)
Entity type:Individual
Prefix:
First Name:MARC LEE
Middle Name:MACALALAG
Last Name:MELENDREZ
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
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Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:310-248-6679
Mailing Address - Fax:310-423-0106
Practice Address - Street 1:127 S SAN VICENTE BLVD STE A3600
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3311
Practice Address - Country:US
Practice Address - Phone:424-315-0129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily