Healthcare Provider Details

I. General information

NPI: 1982740932
Provider Name (Legal Business Name): MELINDA RUTH VANCE TRUP MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4748 ENGLE RD STE 107
CARMICHAEL CA
95608-2232
US

IV. Provider business mailing address

4748 ENGLE RD STE 107
CARMICHAEL CA
95608-2232
US

V. Phone/Fax

Practice location:
  • Phone: 916-482-2273
  • Fax: 916-974-2936
Mailing address:
  • Phone: 916-482-2273
  • Fax: 916-974-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU1245
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA2740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: