MEDICARE: MELVIN VILLEDA B.S

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1649704859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELVIN VILLEDA B.S

Provider Business Mailing Address
First Line	:	504 N ROSE ST
Second Line	:	8BB
City	:	ANAHEIM
State	:	CA
Zip	:	92805-2118
Country	:	US
Telephone Number	:	562-646-6023
Fax Number	:

Provider Business Practice Location Address
First Line	:	2428 NEWPORT BLVD
Second Line	:	8BB
City	:	COSTA MESA
State	:	CA
Zip	:	92627-5171
Country	:	US
Telephone Number	:	714-353-5906
Fax Number	:

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

Provider Enumeration Date	:	04/13/2017
Last Update Date	:	04/13/2017

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