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General NPI Number Information
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NPI Number | 1316956592
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Entity Type | Individual
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Provider Name | ALFRED SIMON MELENDREZ PTA
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Gender | Male
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 15707 VALLEY BLVD
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City | CITY OF INDUSTRY
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State | CA
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Zip | 91744-3932
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Country | US
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Telephone | 626-961-1152
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Fax |
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Provider Business Mailing Address
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Address Line | 1129 N 10TH ST
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City | COLTON
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State | CA
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Zip | 92324-2447
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Country | US
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Telephone | 909-422-1466
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | AT3379
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License Number State | CA
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