=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649132184
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELINDA ISABEL CARMONA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2025
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6309 GLENHURST DR APT 6
-----------------------------------------------------
City | MAUMEE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43537-4148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-350-1668
-----------------------------------------------------
Fax | 419-350-1668
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6309 GLENHURST DR APT 6
-----------------------------------------------------
City | MAUMEE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43537-4148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-350-1668
-----------------------------------------------------
Fax | 419-350-1668
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376J00000X
-----------------------------------------------------
Taxonomy Name | Homemaker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------