MEDICARE: MELANIE MARMOLEJOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker	74043601	PA
2	385H00000X	Respite Care	74043601	PA
3	253Z00000X	In Home Supportive Care Agency	74043601	PA

General Provider Information

NPI Number	:	1417735655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE MARMOLEJOS

Provider Business Mailing Address
First Line	:	2754 N 8TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-2005
Country	:	US
Telephone Number	:	215-602-0706
Fax Number	:

Provider Business Practice Location Address
First Line	:	2754 N 8TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-2005
Country	:	US
Telephone Number	:	215-602-0706
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2023
Last Update Date	:	09/19/2023

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Directions to “ MELANIE MARMOLEJOS ” Practice Location

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