Healthcare Provider Details

I. General information

NPI: 1255430252
Provider Name (Legal Business Name): LORRAINE CELESTE MELENDEZ D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BIRMINGHAM DR SUITE 100
CARDIFF BY THE SEA CA
92007-1757
US

IV. Provider business mailing address

120 BIRMINGHAM DR SUITE 100
CARDIFF BY THE SEA CA
92007-1757
US

V. Phone/Fax

Practice location:
  • Phone: 760-944-0563
  • Fax: 760-944-6773
Mailing address:
  • Phone: 760-944-0563
  • Fax: 760-944-6773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC21155
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number21155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: