Healthcare Provider Details

I. General information

NPI: 1699696781
Provider Name (Legal Business Name): MELISSA HERMOZA MANLIMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 LAS ROSAS AVE
CLOVIS CA
93619-8769
US

IV. Provider business mailing address

3435 LAS ROSAS AVE
CLOVIS CA
93619-8769
US

V. Phone/Fax

Practice location:
  • Phone: 559-577-3885
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number654990
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: