Healthcare Provider Details

I. General information

NPI: 1861448573
Provider Name (Legal Business Name): MELISSA JENNIFER SELNER D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MILVIA ST SUITE 226
BERKELEY CA
94704-2636
US

IV. Provider business mailing address

126 VALLE VERDE CT
DANVILLE CA
94526-1630
US

V. Phone/Fax

Practice location:
  • Phone: 510-841-5771
  • Fax: 510-841-5772
Mailing address:
  • Phone: 818-421-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4640
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: