Healthcare Provider Details

I. General information

NPI: 1447652417
Provider Name (Legal Business Name): MELISSA MARIA GARCIA CFOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 21ST ST SUITE B
BAKERSFIELD CA
93301-4002
US

IV. Provider business mailing address

1524 21ST ST SUITE B
BAKERSFIELD CA
93301-4002
US

V. Phone/Fax

Practice location:
  • Phone: 661-322-1005
  • Fax: 661-322-0528
Mailing address:
  • Phone: 661-322-1005
  • Fax: 661-322-0528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License NumberCFOM0702
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCFOM0702
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: