Healthcare Provider Details

I. General information

NPI: 1215499033
Provider Name (Legal Business Name): STEPHANIE MELCHOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 E ILLINOIS AVE STE 408
FRESNO CA
93701-2184
US

IV. Provider business mailing address

2625 E DIVISADERO ST
FRESNO CA
93721-1431
US

V. Phone/Fax

Practice location:
  • Phone: 559-443-2694
  • Fax: 559-443-2696
Mailing address:
  • Phone: 559-443-2682
  • Fax: 559-443-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA180462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: