Healthcare Provider Details

I. General information

NPI: 1578763751
Provider Name (Legal Business Name): MELANIE ALARCIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 N NORWALK STE 10-119
MESA AZ
85215-1148
US

IV. Provider business mailing address

2812 N NORWALK STE 10-119
MESA AZ
85215-1148
US

V. Phone/Fax

Practice location:
  • Phone: 480-621-8200
  • Fax: 480-621-8283
Mailing address:
  • Phone: 480-621-8200
  • Fax: 480-621-8283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number41095
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA93818
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA93818
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number41095
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: