MEDICARE: JOSE MELENDEZ

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
1	332B00000X	Durable Medical Equipment & Medical Supplies	4434510001	CA

General Provider Information

NPI Number	:	1396779617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE MELENDEZ

Provider Business Mailing Address
First Line	:	2643 E CARSON ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90810-1508
Country	:	US
Telephone Number	:	310-549-0372
Fax Number	:	310-549-6840

Provider Business Practice Location Address
First Line	:	2643 E CARSON ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90810-1508
Country	:	US
Telephone Number	:	310-549-0372
Fax Number	:	310-549-6840

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOSE MELENDEZ
Credential	:
Telephone Number	:	310-549-0372

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	06/23/2008

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