Provider Demographics
NPI:1891594826
Name:DE CARVALHO, MILENA FERNANDES ROMANO I
Entity type:Individual
Prefix:
First Name:MILENA
Middle Name:FERNANDES ROMANO
Last Name:DE CARVALHO
Suffix:I
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21256 BEACH BLVD # B208
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5479
Mailing Address - Country:US
Mailing Address - Phone:424-327-1945
Mailing Address - Fax:
Practice Address - Street 1:21256 BEACH BLVD # B208
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-5479
Practice Address - Country:US
Practice Address - Phone:424-327-1945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91729225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist