Healthcare Provider Details

I. General information

NPI: 1023543006
Provider Name (Legal Business Name): MELENA CALHOUN MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5760 CLIFTON BLVD
RIVERSIDE CA
92504-1520
US

IV. Provider business mailing address

18150 WOOD RD
PERRIS CA
92570-9486
US

V. Phone/Fax

Practice location:
  • Phone: 951-966-0341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: