Healthcare Provider Details

I. General information

NPI: 1881706521
Provider Name (Legal Business Name): MELODIA AQUINO-ELIAZO MD CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
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 Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA42414
License Number StateCA

VIII. Authorized Official

Name: MELODIA AQUINO ELIAZO
Title or Position: M.D./PRESIDENT
Credential: M.D.
Phone: 559-268-9737