Healthcare Provider Details

I. General information

NPI: 1427406933
Provider Name (Legal Business Name): NANCY MELGOZA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 IMPERIAL AVE
DAVIS CA
95616-3161
US

IV. Provider business mailing address

2008 IMPERIAL AVE
DAVIS CA
95616-3161
US

V. Phone/Fax

Practice location:
  • Phone: 530-400-9134
  • Fax:
Mailing address:
  • Phone: 530-400-9134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number48019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: