Healthcare Provider Details

I. General information

NPI: 1699431569
Provider Name (Legal Business Name): MELISSA CUARESMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 OAKSHIRE LN
CHINO HILLS CA
91709-4240
US

IV. Provider business mailing address

3235 OAKSHIRE LN
CHINO HILLS CA
91709-4240
US

V. Phone/Fax

Practice location:
  • Phone: 909-518-8584
  • Fax:
Mailing address:
  • Phone: 909-518-8584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number95230875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: