Basic Information
Provider Information
NPI: 1295023448
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MELENDREZ
FirstName: RONDA
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 25910 ACERO STE 160
Address2:  
City: MISSION VIEJO
State: CA
PostalCode: 926912777
CountryCode: US
TelephoneNumber: 9099806700
FaxNumber: 9099806003
Practice Location
Address1: 9500 HAVEN AVE STE 100
Address2:  
City: RANCHO CUCAMONGA
State: CA
PostalCode: 917305871
CountryCode: US
TelephoneNumber: 9099806700
FaxNumber: 9099806003
Other Information
ProviderEnumerationDate: 07/20/2011
LastUpdateDate: 07/27/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/27/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
172V00000X  Y Other Service ProvidersCommunity Health Worker 

No ID Information.


Home