Provider Demographics
NPI:1174555460
Name:MELENDEZ, RONNIE LEE
Entity type:Individual
Prefix:
First Name:RONNIE
Middle Name:LEE
Last Name:MELENDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:RON
Other - Middle Name:L
Other - Last Name:MELENDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 661360
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-1360
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:1300 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3505
Practice Address - Country:US
Practice Address - Phone:310-514-5350
Practice Address - Fax:310-514-5421
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61266207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G612660Medicaid
CAHG61266Medicare PIN
CAE07545Medicare UPIN
CAWG61266JMedicare PIN