Healthcare Provider Details

I. General information

NPI: 1861644635
Provider Name (Legal Business Name): MELANIE M TROWBRIDGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MISSION BLVD SUITE 2800
JACKSON CA
95642-2536
US

IV. Provider business mailing address

100 MISSION BLVD SUITE 2800
JACKSON CA
95642-2536
US

V. Phone/Fax

Practice location:
  • Phone: 209-257-0177
  • Fax: 209-257-0176
Mailing address:
  • Phone: 209-257-0177
  • Fax: 209-257-0176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberG78564
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberG78564
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: