Basic Information
| Provider Information | |||||||||
| NPI: | 1841253978 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELENDEZ | ||||||||
| FirstName: | CHRISTIAN | ||||||||
| MiddleName: | TOMAS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 94-149 KUAHELANI AVE | ||||||||
| Address2: | #158 | ||||||||
| City: | MILILANI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967892332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084731880 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 480 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | PEARL HARBOR | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968604908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084731880 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 582443 | CA | X | Nursing Service Providers | Registered Nurse | 163W00000X | RN38195 | RI | X | Nursing Service Providers | Registered Nurse |
No ID Information.