Healthcare Provider Details

I. General information

NPI: 1053339606
Provider Name (Legal Business Name): MELISSA ROSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. MELISSA BONDER

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 SUNSET LN SUITE 6
ANTIOCH CA
94509-6199
US

IV. Provider business mailing address

11875 DUBLIN BLVD SUITE C140
DUBLIN CA
94568-2843
US

V. Phone/Fax

Practice location:
  • Phone: 925-755-8500
  • Fax: 925-755-8200
Mailing address:
  • Phone: 925-587-2500
  • Fax: 925-587-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07624600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA112131
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: