Healthcare Provider Details

I. General information

NPI: 1427598390
Provider Name (Legal Business Name): MELINA GOMEZ LOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 HILBURT ST #2
PASADENA CA
91105
US

IV. Provider business mailing address

650 LA SEDA RD 17 C
LA PUENTE CA
91744
US

V. Phone/Fax

Practice location:
  • Phone: 626-441-4221
  • Fax:
Mailing address:
  • Phone: 626-935-5146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN685247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: