Provider Demographics
NPI:1831351972
Name:VENERACION, CARMELO SINGSON
Entity type:Individual
Prefix:MR
First Name:CARMELO
Middle Name:SINGSON
Last Name:VENERACION
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MEL
Other - Middle Name:S
Other - Last Name:VENERACION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1627 PASEO CARINA DR
Mailing Address - Street 2:#2
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915
Mailing Address - Country:US
Mailing Address - Phone:901-379-0902
Mailing Address - Fax:
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0002
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4544225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist