Healthcare Provider Details

I. General information

NPI: 1114179447
Provider Name (Legal Business Name): MS. MELVA DELL HUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 N ARROWHEAD AVE
SAN BERNARDINO CA
92405-2245
US

IV. Provider business mailing address

3720 N ARROWHEAD AVE
SAN BERNARDINO CA
92405-2245
US

V. Phone/Fax

Practice location:
  • Phone: 909-496-4161
  • Fax:
Mailing address:
  • Phone: 909-496-4161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN183956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: