Provider Demographics
NPI:1982682969
Name:MELCHOR, ROSEMARIE JOSE (MD)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:JOSE
Last Name:MELCHOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11432 SOUTH ST
Mailing Address - Street 2:376
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6611
Mailing Address - Country:US
Mailing Address - Phone:562-552-0321
Mailing Address - Fax:
Practice Address - Street 1:10802 COLLEGE PL
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6743
Practice Address - Country:US
Practice Address - Phone:562-924-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA70429FOtherMEDICARE ID
CAWA70429AMedicare ID - Type UnspecifiedINDIVIDUAL
CAWA70429FOtherMEDICARE ID