Healthcare Provider Details

I. General information

NPI: 1285813170
Provider Name (Legal Business Name): MELODIA AQUINO ELIAZO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 R ST
FRESNO CA
93721-1312
US

IV. Provider business mailing address

1045 R ST
FRESNO CA
93721-1312
US

V. Phone/Fax

Practice location:
  • Phone: 559-268-9737
  • Fax: 559-268-0279
Mailing address:
  • Phone: 559-268-9737
  • Fax: 559-268-0279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA42414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: