Healthcare Provider Details

I. General information

NPI: 1831288844
Provider Name (Legal Business Name): MELANI VERAN-DE LOS REYES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 W. SIXTH STREET STE. 200
SAN PEDRO CA
90732-3514
US

IV. Provider business mailing address

1360 W. SIXTH STREET STE. 200
SAN PEDRO CA
90732-3514
US

V. Phone/Fax

Practice location:
  • Phone: 310-547-9922
  • Fax: 310-547-4673
Mailing address:
  • Phone: 310-547-9922
  • Fax: 310-547-4673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number531463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: