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NPI Code Detail

MEDICARE: MELQUADES REYES CANANES III LVN

MEDICARE: MELQUADES REYES CANANES III LVN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164X00000XLicensed Vocational Nurse166495CA

General Provider Information

NPI Number : 1053496661
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELQUADES REYES CANANES III LVN
Provider Business Mailing Address
First Line : 7570 HUGHES ST
Second Line :
City : LEMON GROVE
State : CA
Zip : 91945-4032
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7922 PALM ST
Second Line :
City : LEMON GROVE
State : CA
Zip : 91945-2956
Country : US
Telephone Number : 619-464-3488
Fax Number : 619-464-3416
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 07/08/2007

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