Provider Demographics
NPI:1316605686
Name:MELGOZA, LUIS SANCHEZ
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:SANCHEZ
Last Name:MELGOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 E HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2242
Mailing Address - Country:US
Mailing Address - Phone:559-313-1835
Mailing Address - Fax:
Practice Address - Street 1:554 E HOWARD ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2242
Practice Address - Country:US
Practice Address - Phone:559-313-1835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9793225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant