Healthcare Provider Details

I. General information

NPI: 1225237027
Provider Name (Legal Business Name): MELODY A LEHMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1873 COMMERCENTER W
SAN BERNARDINO CA
92408-3303
US

IV. Provider business mailing address

700 S TUSTIN ST
ORANGE CA
92866-3425
US

V. Phone/Fax

Practice location:
  • Phone: 909-890-5511
  • Fax:
Mailing address:
  • Phone: 909-922-4198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number458557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: