Healthcare Provider Details

I. General information

NPI: 1568283968
Provider Name (Legal Business Name): MELISSA DEL PRADO BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
FAIRFIELD CA
94535-1809
US

IV. Provider business mailing address

101 BODIN CIR
FAIRFIELD CA
94535-1809
US

V. Phone/Fax

Practice location:
  • Phone: 510-426-2187
  • Fax:
Mailing address:
  • Phone: 707-423-3305
  • Fax: 707-423-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number928867
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: