MEDICARE: FABIANA MELO DDS

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	122300000X	Dentist	54923	CA

General Provider Information

NPI Number	:	1982720058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FABIANA MELO DDS

Provider Business Mailing Address
First Line	:	211 EL CAMINO REAL
Second Line	:
City	:	SAN BRUNO
State	:	CA
Zip	:	94066-4838
Country	:	US
Telephone Number	:	650-589-4784
Fax Number	:	650-589-4153

Provider Business Practice Location Address
First Line	:	485 BROADWAY STE 700
Second Line	:
City	:	MILLBRAE
State	:	CA
Zip	:	94030-1923
Country	:	US
Telephone Number	:	650-576-4341
Fax Number	:

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	02/11/2020

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