Provider Demographics
NPI:1649704859
Name:VILLEDA, MELVIN (BS)
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:
Last Name:VILLEDA
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 N ROSE ST
Mailing Address - Street 2:8BB
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2118
Mailing Address - Country:US
Mailing Address - Phone:562-646-6023
Mailing Address - Fax:
Practice Address - Street 1:2428 NEWPORT BLVD
Practice Address - Street 2:8BB
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-5171
Practice Address - Country:US
Practice Address - Phone:714-353-5906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)