Provider Demographics
NPI:1881103620
Name:CALLEJAS HILLARIO, MELINDA
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:CALLEJAS HILLARIO
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 1:1155 N GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-3990
Mailing Address - Country:US
Mailing Address - Phone:919-641-6000
Mailing Address - Fax:
Practice Address - Street 1:1155 N GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-3990
Practice Address - Country:US
Practice Address - Phone:919-641-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home