Healthcare Provider Details

I. General information

NPI: 1861722621
Provider Name (Legal Business Name): MELISSA A. MARK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA A VALDELLON

II. Dates (important events)

Enumeration Date: 12/30/2009
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DWIGHT WAY FL 2
BERKELEY CA
94704-2608
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-5770
  • Fax: 510-204-5749
Mailing address:
  • Phone: 510-204-1591
  • Fax: 510-204-5749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP21279
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP010669
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number21279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: