Healthcare Provider Details

I. General information

NPI: 1215306964
Provider Name (Legal Business Name): MELINDA OLIVENCIA-LOZADA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 VINEYARD WAY STE 200
WEST GROVE PA
19390-8849
US

IV. Provider business mailing address

731 W CYPRESS ST
KENNETT SQUARE PA
19348-2419
US

V. Phone/Fax

Practice location:
  • Phone: 610-444-7550
  • Fax:
Mailing address:
  • Phone: 610-444-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number9322861
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: