MEDICARE: MS. MELISSA RAE STARKS CASR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	9364	CA

General Provider Information

NPI Number	:	1093044257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA RAE STARKS CASR

Provider Business Mailing Address
First Line	:	2914 COLD SPRINGS RD STE A
Second Line	:	PO BOX 1666
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-4237
Country	:	US
Telephone Number	:	530-642-1715
Fax Number	:	530-642-2064

Provider Business Practice Location Address
First Line	:	2914 COLD SPRINGS RD STE A
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-4237
Country	:	US
Telephone Number	:	530-642-1715
Fax Number	:	530-642-2064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2009
Last Update Date	:	12/17/2009

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