Provider Demographics
NPI:1871532218
Name:DENUCCIO-MELENDEZ, CARA J (MPT)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:J
Last Name:DENUCCIO-MELENDEZ
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27192 SUN CITY BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2577
Mailing Address - Country:US
Mailing Address - Phone:951-301-0507
Mailing Address - Fax:951-301-0510
Practice Address - Street 1:27192 SUN CITY BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-2577
Practice Address - Country:US
Practice Address - Phone:951-301-0507
Practice Address - Fax:951-301-0510
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT193290Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID @